Provider Demographics
NPI:1174356422
Name:STAY HOME WOUND CARE PC
Entity type:Organization
Organization Name:STAY HOME WOUND CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-513-3100
Mailing Address - Street 1:26200 TOWN CENTER DR STE 165
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1219
Mailing Address - Country:US
Mailing Address - Phone:734-646-2286
Mailing Address - Fax:
Practice Address - Street 1:26200 TOWN CENTER DR STE 165
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1219
Practice Address - Country:US
Practice Address - Phone:734-646-2286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty