MEDICARE: ENNOBLEMENT ELEVEN ENTERPRISES 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	:	1649125956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENNOBLEMENT ELEVEN ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	17191 EDWARDS AVE
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-2034
Country	:	US
Telephone Number	:	248-533-1230
Fax Number	:	248-533-1230

Provider Business Practice Location Address
First Line	:	17191 EDWARDS AVE
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-2034
Country	:	US
Telephone Number	:	248-533-1230
Fax Number	:	248-533-1230

Authorized Official
Title or Position	:	OWNER
Name	:	JACQUELYNN BRADSHAW
Credential	:	BRADSHAW
Telephone Number	:	248-533-1230

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/24/2026

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