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Elizabeth Samantha Kole

Social Worker

Behavioral Health & Social Service Providers

6960 Orchard Lake Rd Ste 100, West Bloomfield, MI 48322-4523

PECOS Enrollment

This provider is enrolled in PECOS as ELIZABETH KOLE.

Based on the most recent information from CMS, provider Elizabeth Samantha Kole is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 11:21 AM.

Profile Details

Provider ID
1265969224
Provider Type
Individual
Full Name
Kole, Elizabeth Samantha
Title
Ms.
Credential
LMSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
5/21/2017
Last Updated
8/22/2022

Contact Information

Practice Location

6960 Orchard Lake Rd Ste 100, West Bloomfield, MI 48322-4523

(248) 648-3406

Unlisted Fax

Mailing Location

1006 Humphrey Ave, Birmingham, MI 48009-3642

(248) 444-1667

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 104100000X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 6801105598 Michigan
Code 104100000X	Description Social Worker Behavioral Health & Social Service Providers	License Unlisted Issuer
Code 1041C0700X	Description Social Worker Behavioral Health & Social Service Providers	License 6801100998 Michigan

Elizabeth Samantha Kole

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

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