| Selective Care Case Management Llc | |
|
24100 Southfield Rd Southfield MI 48075-2819 | |
| (248) 210-6001 | |
| Not Available |
| Full Name | Selective Care Case Management Llc |
|---|---|
| Speciality | Social Worker |
| Location | 24100 Southfield Rd, Southfield, Michigan |
| Authorized Official Name and Position | Jacalyn Beavers (ADMINSTRATOR) |
| Authorized Official Contact | 2482106001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Selective Care Case Management Llc 30700 Telegraph Rd Ste 1645 Bingham Farms MI 48025-4525 Ph: (248) 283-1100 | Selective Care Case Management Llc 24100 Southfield Rd Southfield MI 48075-2819 Ph: (248) 210-6001 |
| NPI Number | 1639773419 |
|---|---|
| Provider Enumeration Date | 11/23/2020 |
| Last Update Date | 11/23/2020 |
| Certification Date | 11/23/2020 |
| Medicare PECOS PAC ID | 2961814066 |
|---|---|
| Medicare Enrollment ID | O20201215000379 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639773419 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jacalyn Beavers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952412322 PECOS PAC ID: 6406925619 Enrollment ID: I20080514000327 |
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