Healthcare Provider Details

I. General information

NPI: 1710802236
Provider Name (Legal Business Name): AZARIA LEGACY HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33211 CHERYL ST
CLINTON TWP MI
48035-3928
US

IV. Provider business mailing address

33211 CHERYL ST
CLINTON TWP MI
48035-3928
US

V. Phone/Fax

Practice location:
  • Phone: 586-383-7055
  • 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: LATOYA MARBLE
Title or Position: OWNER/CEO
Credential:
Phone: 586-383-7055