Provider Demographics
NPI:1487754545
Name:METRO DETROIT RESPIRATORY HOME CARE
Entity type:Organization
Organization Name:METRO DETROIT RESPIRATORY HOME CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILBERT
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-863-7711
Mailing Address - Street 1:16909 LIVERNOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-3058
Mailing Address - Country:US
Mailing Address - Phone:313-863-3710
Mailing Address - Fax:
Practice Address - Street 1:16909 LIVERNOIS AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-3058
Practice Address - Country:US
Practice Address - Phone:313-863-3710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883360Medicaid
MI0340500001Medicare NSC