Healthcare Provider Details

I. General information

NPI: 1104226786
Provider Name (Legal Business Name): LOVING HEART HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12875 ARCHDALE
DETROIT MI
48227
US

IV. Provider business mailing address

12875 ARCHDALE ST
DETROIT MI
48227-1265
US

V. Phone/Fax

Practice location:
  • Phone: 248-228-0075
  • Fax:
Mailing address:
  • Phone: 248-228-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DESHONNA LAFAY MARTIN I
Title or Position: HOME CARE ASSISTANT
Credential: MA,CNA
Phone: 248-228-0075