Provider Demographics
NPI:1487438487
Name:BEAUTIFUL MACK HOME CARE LLC
Entity type:Organization
Organization Name:BEAUTIFUL MACK HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-923-5176
Mailing Address - Street 1:23332 FARMINGTON RD # 279
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-9991
Mailing Address - Country:US
Mailing Address - Phone:248-923-5176
Mailing Address - Fax:
Practice Address - Street 1:23332 FARMINGTON RD # 279I
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-9991
Practice Address - Country:US
Practice Address - Phone:248-923-5176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care