Basic Information
| Provider Information | |||||||||
| NPI: | 1417930207 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MERCY GENERAL HEALTH PARTNERS AMICARE HOMECARE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MERCY VNS AND HOSPICE SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 9185 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483339185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343436570 | ||||||||
| FaxNumber: | 7343436451 | ||||||||
| Practice Location | |||||||||
| Address1: | 888 TERRACE ST | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494401220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316724663 | ||||||||
| FaxNumber: | 2316726263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2005 | ||||||||
| LastUpdateDate: | 03/01/2017 | ||||||||
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| AuthorizedOfficialLastName: | KNITTEL | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7343436512 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 613512 | MI | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 08791 | 01 | MI | BLUE CROSS & BLUE SHIELD | OTHER | 08791 | 01 | MI | BLUE CHOICE | OTHER | 800002010 | 01 | MI | PRIORITY HEALTH | OTHER | 4271950 | 05 | MI | MEDICAID | 08791 | 01 | MI | BLUE CARE NETWORK | OTHER | 30937 | 01 | MI | HEALTH PLAN OF MICHIGAN | OTHER |