Provider Demographics
NPI:1366226698
Name:MI CARE PROVIDER LLC
Entity type:Organization
Organization Name:MI CARE PROVIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHIBLU
Authorized Official - Middle Name:F
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-876-5513
Mailing Address - Street 1:30500 VAN DYKE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2109
Mailing Address - Country:US
Mailing Address - Phone:586-876-5513
Mailing Address - Fax:
Practice Address - Street 1:30500 VAN DYKE AVE STE 201
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2109
Practice Address - Country:US
Practice Address - Phone:586-876-5513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health