Healthcare Provider Details

I. General information

NPI: 1679409890
Provider Name (Legal Business Name): INDEPENDENCE SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22313 GREGORY ST APT 2
DEARBORN MI
48124-3795
US

IV. Provider business mailing address

22313 GREGORY ST APT 2
DEARBORN MI
48124-3795
US

V. Phone/Fax

Practice location:
  • Phone: 617-688-7761
  • Fax:
Mailing address:
  • Phone: 617-688-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA KELLEE MENDES-YESUFU
Title or Position: CEO
Credential:
Phone: 617-688-7761