Country Club Home Care LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

COUNTRY CLUB HOME CARE LLC

Practice address

4120 W Maple Rd
Suite 201
Bloomfield Hills, MI 48301-3010

Phone

(248) 626-8500

Fax

(248) 539-9740

NPI assigned

Mar 16, 2009

Organization subpart

No

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

Authorized official

Name

Rose Marie Mansel, R.N.

Title

President

Phone

(248) 626-8500

Specialties & licenses 1

Addresses

Tax ID family

Country Club Home Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Country Club Home Care LLC

  • Home Health Agency
  • West Bloomfield, MI
  • NPI 1871896456
  NPD tax ID

Locations

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

{
    "created_epoch": "1237161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237161600000",
    "number": "1629219910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4120 W MAPLE RD",
            "address_2": "SUITE 201",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483013010",
            "telephone_number": "248-626-8500",
            "fax_number": "248-539-9740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4120 W MAPLE RD",
            "address_2": "SUITE 201",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483013010",
            "telephone_number": "248-626-8500",
            "fax_number": "248-539-9740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CLUB HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-16",
        "last_updated": "2009-03-16",
        "status": "A",
        "authorized_official_last_name": "MANSEL",
        "authorized_official_first_name": "ROSE MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-626-8500",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kristen C Couture, OTR
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• Covenant Home Care LLC
• Covenant Home Care Ministries

• In Home Supportive Care Agency in Bloomfield Hills, MI
• Providers in Bloomfield Hills, MI by specialty
• In Home Supportive Care Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2009; 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.