Provider Demographics
NPI:1366194144
Name:COOK, CAROLINE (HOME CARE PROVIDER)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:HOME CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 613
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-0613
Mailing Address - Country:US
Mailing Address - Phone:313-208-3020
Mailing Address - Fax:586-586-2830
Practice Address - Street 1:8700 CONTINENTAL AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1790
Practice Address - Country:US
Practice Address - Phone:586-806-6966
Practice Address - Fax:586-283-0380
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7765358Medicaid