Provider Demographics
NPI:1801283809
Name:NORTHERN HOMECARE, CASE MANAGEMENT & STAFFING INC
Entity type:Organization
Organization Name:NORTHERN HOMECARE, CASE MANAGEMENT & STAFFING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AJAERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-499-4038
Mailing Address - Street 1:20919 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-5975
Mailing Address - Country:US
Mailing Address - Phone:248-499-4038
Mailing Address - Fax:
Practice Address - Street 1:20919 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-5975
Practice Address - Country:US
Practice Address - Phone:248-499-4038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4206364251B00000X
MI253Z00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care