MEDICARE: HEARTSTEAD HOME CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1164350658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTSTEAD HOME CARE LLC

Provider Business Mailing Address
First Line	:	41021 OLD MICHIGAN AVE TRLR 221
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-2728
Country	:	US
Telephone Number	:	248-200-6168
Fax Number	:

Provider Business Practice Location Address
First Line	:	41021 OLD MICHIGAN AVE TRLR 221
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-2728
Country	:	US
Telephone Number	:	248-200-6168
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHONTASSIA D WOODS
Credential	:
Telephone Number	:	248-200-6168

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/18/2026

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