NPIMap

Organization Active NPI

Bloomingdale Senior Services LLC

  • In Home Supportive Care Agency
  • Bloomingdale, MI
National Provider Identifier
1366178105
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
BLOOMINGDALE SENIOR SERVICES LLC
Practice address
01546 County Road 665
Bloomingdale, MI 49026-8756
Phone
(269) 512-6163
NPI assigned
Jul 25, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Terry L McCullough, MSWNPI 1801530571
Title
Director
Phone
(269) 512-6163

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X Primary
Home Delivered Meals 332U00000X
Non-emergency Medical Transport (VAN) 343900000X

Addresses

Primary practice location

01546 County Road 665
Bloomingdale, MI 49026-8756

Mailing address

01546 County Road 665
Bloomingdale, MI 49026-8756
Phone (269) 512-6163

Other identifiers 1

IdentifierTypeStateIssuer
9689166MedicaidMI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658707200000",
    "number": "1366178105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "01546 COUNTY ROAD 665",
            "city": "BLOOMINGDALE",
            "state": "MI",
            "postal_code": "490268756",
            "telephone_number": "269-512-6163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "01546 COUNTY ROAD 665",
            "city": "BLOOMINGDALE",
            "state": "MI",
            "postal_code": "490268756",
            "telephone_number": "269-512-6163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGDALE SENIOR SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-25",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A",
        "authorized_official_last_name": "MCCULLOUGH",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "269-512-6163",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332U00000X",
            "taxonomy_group": "",
            "desc": "Home Delivered Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9689166",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomingdale, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.