MEDICARE: BETTY HOLMES

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1407683816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY HOLMES

Provider Business Mailing Address
First Line	:	7151 COPPER CREEK CIR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-2498
Country	:	US
Telephone Number	:	734-765-0797
Fax Number	:

Provider Business Practice Location Address
First Line	:	29066 ETON ST
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48186-5196
Country	:	US
Telephone Number	:	734-721-2557
Fax Number	:

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

Provider Enumeration Date	:	09/18/2024
Last Update Date	:	01/18/2026

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