MEDICARE: MOTHER'S HEART LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	385H00000X	Respite Care
3	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1770208092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTHER'S HEART LLC

Provider Business Mailing Address
First Line	:	PO BOX 2658
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48123-2658
Country	:	US
Telephone Number	:	872-216-7015
Fax Number	:

Provider Business Practice Location Address
First Line	:	23169 MICHIGAN AVE # 2658
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-0001
Country	:	US
Telephone Number	:	872-216-7015
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KEISHA L MAGEE
Credential	:
Telephone Number	:	872-333-6437

Provider Enumeration Date	:	10/10/2022
Last Update Date	:	10/10/2022

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Directions to “MOTHER'S HEART LLC ” Practice Location

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