Provider Demographics
NPI:1811978703
Name:ULTIMACARE HOME HEALTH INC.
Entity type:Organization
Organization Name:ULTIMACARE HOME HEALTH INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-943-2552
Mailing Address - Street 1:2785 GARFIELD RD N STE C
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-5168
Mailing Address - Country:US
Mailing Address - Phone:231-943-2552
Mailing Address - Fax:231-943-2555
Practice Address - Street 1:2785 GARFIELD RD N STE C
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-5168
Practice Address - Country:US
Practice Address - Phone:231-943-2552
Practice Address - Fax:231-943-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI237514251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4710175Medicaid
MI237514Medicare PIN