Provider Demographics
NPI:1174609218
Name:MCGUFFEY HOME HEALTH CARE, LLC
Entity type:Organization
Organization Name:MCGUFFEY HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING & ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:POLEMITIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:248-890-3235
Mailing Address - Street 1:3250 COOLIDGE HWY STE A
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1634
Mailing Address - Country:US
Mailing Address - Phone:248-591-9200
Mailing Address - Fax:248-591-0623
Practice Address - Street 1:3250 COOLIDGE HWY STE A
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1634
Practice Address - Country:US
Practice Address - Phone:248-591-9200
Practice Address - Fax:248-591-0623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237693Medicare Oscar/Certification