MEDICARE: PLEASANT LIFE HOME CARE SERVICES, 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1912676719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLEASANT LIFE HOME CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	20418 LOCHMOOR ST
Second Line	:
City	:	HARPER WOODS
State	:	MI
Zip	:	48225-1750
Country	:	US
Telephone Number	:	248-554-7665
Fax Number	:	313-536-8879

Provider Business Practice Location Address
First Line	:	2785 E GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-2003
Country	:	US
Telephone Number	:	313-536-8878
Fax Number	:	313-536-8879

Authorized Official
Title or Position	:	CNA/HHA
Name	:	STEPHANIE F EDWARDS
Credential	:	CERT
Telephone Number	:	248-554-7665

Provider Enumeration Date	:	09/07/2021
Last Update Date	:	10/01/2021

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