Basic Information
| Provider Information | |||||||||
| NPI: | 1124117023 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOLY CROSS CARENET INC | ||||||||
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| OtherOrganizationName: | HOLY CROSS REHABILITATION AND NURSING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9184 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483339184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483057919 | ||||||||
| FaxNumber: | 2483057677 | ||||||||
| Practice Location | |||||||||
| Address1: | 3415 GREENCASTLE RD | ||||||||
| Address2: | |||||||||
| City: | BURTONSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208661715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013881400 | ||||||||
| FaxNumber: | 3018794512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 06/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | JACKIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2483057688 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332BN1400X | 15-071 15633 | MD | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies |
ID Information
| ID | Type | State | Issuer | Description | 404789300 | 05 | MD | MEDICAID |