Basic Information
| Provider Information | |||||||||
| NPI: | 1720517113 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THERAMEDIC HOME HEALTH CARE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THERAMEDIC HEALTH GROUP LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26400 W 12 MILE RD STE 80 | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480341700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485654000 | ||||||||
| FaxNumber: | 2485654020 | ||||||||
| Practice Location | |||||||||
| Address1: | 26400 W. 12 MILE RD | ||||||||
| Address2: | SUITE 80 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485654000 | ||||||||
| FaxNumber: | 2485654020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | MAMTORA | ||||||||
| AuthorizedOfficialFirstName: | PANKAJ | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2485654000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | RPT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.