Provider Demographics
NPI:1043708357
Name:MEADOWLARK HOME CARE INC.
Entity type:Organization
Organization Name:MEADOWLARK HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DEVOUGHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-240-7647
Mailing Address - Street 1:23580 MEADOWLARK ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2275
Mailing Address - Country:US
Mailing Address - Phone:248-545-0133
Mailing Address - Fax:248-864-8724
Practice Address - Street 1:23580 MEADOWLARK ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2275
Practice Address - Country:US
Practice Address - Phone:248-545-0133
Practice Address - Fax:248-864-8724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS630247107253J00000X
320600000X, 320700000X, 320800000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities