MEDICARE: ENDLESS LOVE 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	:	1588320584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDLESS LOVE HOME CARE LLC

Provider Business Mailing Address
First Line	:	8600 CAMERON ST APT 112
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-1205
Country	:	US
Telephone Number	:	313-989-8572
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 CAMERON ST APT 112
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-1205
Country	:	US
Telephone Number	:	313-989-8572
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISHA MCGUIRE
Credential	:	MA, HOME HELP
Telephone Number	:	313-989-8572

Provider Enumeration Date	:	11/14/2021
Last Update Date	:	11/14/2021

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