Healthcare Provider Details

I. General information

NPI: 1992823967
Provider Name (Legal Business Name): CHS OF GREATER DETROIT,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19830 JAMES COUZENS FWY SUITE A
DETROIT MI
48235-1938
US

IV. Provider business mailing address

19830 JAMES COUZENS FWY SUITE A
DETROIT MI
48235-1938
US

V. Phone/Fax

Practice location:
  • Phone: 313-341-8810
  • Fax: 313-341-8820
Mailing address:
  • Phone: 313-341-8810
  • Fax: 313-341-8820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHY R HARRIS
Title or Position: EXECUTIVE DIRECTOR
Credential: R.N. PHD
Phone: 313-341-8810