Provider Demographics
NPI:1043350416
Name:SOUTHWEST MICHIGAN HOME CARE SERVICES, INC
Entity type:Organization
Organization Name:SOUTHWEST MICHIGAN HOME CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:BAS
Authorized Official - Last Name:MADANGUIT
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA
Authorized Official - Phone:269-468-7142
Mailing Address - Street 1:6633 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:COLOMA
Mailing Address - State:MI
Mailing Address - Zip Code:49038-8717
Mailing Address - Country:US
Mailing Address - Phone:269-468-7142
Mailing Address - Fax:269-468-7143
Practice Address - Street 1:6633 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:COLOMA
Practice Address - State:MI
Practice Address - Zip Code:49038-8717
Practice Address - Country:US
Practice Address - Phone:269-468-7142
Practice Address - Fax:269-468-7143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherEMPLOYER IDENTIFICATION N
MI=========OtherEMPLOYER IDENTIFICATION N