MEDICARE: LADONNA TAYLOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	372600000X	Adult Companion
2	3747P1801X	Personal Care Attendant
3	385H00000X	Respite Care
4	372500000X	Chore Provider	MI

General Provider Information

NPI Number	:	1164168001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LADONNA TAYLOR

Provider Business Mailing Address
First Line	:	16523 HARTWELL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-4238
Country	:	US
Telephone Number	:	313-326-0782
Fax Number	:

Provider Business Practice Location Address
First Line	:	16523 HARTWELL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-4238
Country	:	US
Telephone Number	:	313-326-0782
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	05/11/2022

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Directions to “ LADONNA TAYLOR ” Practice Location

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