Healthcare Provider Details

I. General information

NPI: 1316860661
Provider Name (Legal Business Name): CROWN HAVEN HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 KINGS WAY
CANTON MI
48188-1187
US

IV. Provider business mailing address

223 KINGS WAY
CANTON MI
48188-1187
US

V. Phone/Fax

Practice location:
  • Phone: 347-757-7553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: OMOLADE AYODELE
Title or Position: DIRECTOR
Credential:
Phone: 347-757-7553