Healthcare Provider Details

I. General information

NPI: 1366373664
Provider Name (Legal Business Name): ANGEL HANDS RESIDENTIAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 W SQUARE LAKE RD
BLOOMFIELD HILLS MI
48302-0462
US

IV. Provider business mailing address

7 W SQUARE LAKE RD
BLOOMFIELD HILLS MI
48302-0462
US

V. Phone/Fax

Practice location:
  • Phone: 734-578-2781
  • Fax:
Mailing address:
  • Phone: 734-578-2781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code364SL0600X
TaxonomyLong-Term Care Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. FELICIA E TANDOH
Title or Position: PRESIDENT
Credential:
Phone: 248-975-5526