Provider Demographics
NPI:1023102019
Name:HOLY CROSS CARENET INC
Entity type:Organization
Organization Name:HOLY CROSS CARENET INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-542-8348
Mailing Address - Street 1:PO BOX 9184
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-9184
Mailing Address - Country:US
Mailing Address - Phone:734-542-8300
Mailing Address - Fax:734-542-8384
Practice Address - Street 1:3415 GREENCASTLE RD
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1715
Practice Address - Country:US
Practice Address - Phone:301-388-1400
Practice Address - Fax:301-879-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15-071 15633314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD41700900Medicaid
MD9511016 00Medicaid
MD21-5315Medicare Oscar/Certification