Healthcare Provider Details

I. General information

NPI: 1023419199
Provider Name (Legal Business Name): KIMMY;S NEST HOME CARE L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16158 DEXTER AVE
DETROIT MI
48221-3002
US

IV. Provider business mailing address

16158 DEXTER AVE
DETROIT MI
48221-3002
US

V. Phone/Fax

Practice location:
  • Phone: 313-772-3361
  • Fax: 313-864-4109
Mailing address:
  • Phone: 313-772-3361
  • Fax: 313-864-4109

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY SIMONA JONES
Title or Position: HOME CARE
Credential:
Phone: 313-772-3361