Provider Demographics
NPI:1811304314
Name:SPECIALIZED HOMECARE INC
Entity type:Organization
Organization Name:SPECIALIZED HOMECARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CICHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-944-9800
Mailing Address - Street 1:1535 HIGHWOOD E
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-1234
Mailing Address - Country:US
Mailing Address - Phone:877-944-9800
Mailing Address - Fax:248-409-0403
Practice Address - Street 1:4039 40TH ST SE STE 3
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-4123
Practice Address - Country:US
Practice Address - Phone:616-575-9281
Practice Address - Fax:616-575-9282
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIALIZED HOMECARE ADVENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-16
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI87-4667092Medicaid
5179500001Medicare NSC