Healthcare Provider Details

I. General information

NPI: 1457038374
Provider Name (Legal Business Name): SPECTRUM HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 07/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 SANDRA CT
DEARBORN HEIGHTS MI
48127-4137
US

IV. Provider business mailing address

767 SANDRA CT
DEARBORN HEIGHTS MI
48127-4137
US

V. Phone/Fax

Practice location:
  • Phone: 313-333-9235
  • Fax:
Mailing address:
  • Phone: 313-333-9235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: FATME ZAIOUR
Title or Position: RN/NP, OWNER
Credential: DNP, NP, RN
Phone: 313-333-9235