Country Club Home Care LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

4704245086 Issued in MI

Legal business name

COUNTRY CLUB HOME CARE LLC

Practice address

6477 Heritage
West Bloomfield, MI 48322-1339

Phone

(866) 596-9111

Fax

(866) 596-9111

NPI assigned

Dec 21, 2010

Organization subpart

No

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

Authorized official

Name

Ms. Rose Marie Mansel, REGISTERED NURSE

Title

Owner

Phone

(248) 346-1233

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

  • In Home Supportive Care Agency
  • Bloomfield Hills, MI
  • NPI 1629219910
  NPD tax ID

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

{
    "created_epoch": "1292889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292889600000",
    "number": "1871896456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2554 S ROCHESTER RD",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483073817",
            "telephone_number": "866-596-9111",
            "fax_number": "866-596-9111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6477 HERITAGE",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483221339",
            "telephone_number": "866-596-9111",
            "fax_number": "866-596-9111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CLUB HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-21",
        "last_updated": "2010-12-21",
        "status": "A",
        "authorized_official_last_name": "MANSEL",
        "authorized_official_first_name": "ROSE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-346-1233",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "REGISTERED NURSE"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MI",
            "license": "4704245086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in West Bloomfield, MI
• Providers in West Bloomfield, MI by specialty
• Home Health Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2010; 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.