Provider Demographics
NPI:1548951015
Name:SOLACE PRIVATE DUTY INC.
Entity type:Organization
Organization Name:SOLACE PRIVATE DUTY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAU
Authorized Official - Middle Name:
Authorized Official - Last Name:GOFAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-606-7233
Mailing Address - Street 1:PO BOX 2284
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-2284
Mailing Address - Country:US
Mailing Address - Phone:248-766-2746
Mailing Address - Fax:
Practice Address - Street 1:19315 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-6596
Practice Address - Country:US
Practice Address - Phone:248-766-2746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health