Healthcare Provider Details

I. General information

NPI: 1174949770
Provider Name (Legal Business Name): INTEGRATIVE HOME HEALTH PALLIATIVE & HOSPICE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 CAMPAU FARMS CIR
DETROIT MI
48207-5169
US

IV. Provider business mailing address

1707 CAMPAU FARMS CIR
DETROIT MI
48207-5169
US

V. Phone/Fax

Practice location:
  • Phone: 248-613-1221
  • Fax:
Mailing address:
  • Phone: 248-613-1221
  • Fax:

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 Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFERSON DAVIS RIDGEWAY III
Title or Position: PRESIDENT/CEO
Credential:
Phone: 248-613-1221