Healthcare Provider Details

I. General information

NPI: 1669863098
Provider Name (Legal Business Name): LOVING HANDS ACCESSIBLE SERVICE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16230 MENDOTA
DETROIT MI
48221
US

IV. Provider business mailing address

16230 MENDOTA
DETROIT MI
48221
US

V. Phone/Fax

Practice location:
  • Phone: 313-320-0127
  • Fax:
Mailing address:
  • Phone: 313-320-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberW416690018197
License Number StateMI

VIII. Authorized Official

Name: MS. PORTIA WOOLFORK
Title or Position: CEO
Credential:
Phone: 313-320-0127