Healthcare Provider Details

I. General information

NPI: 1336052315
Provider Name (Legal Business Name): HEARTS 4 HAIR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19137 WASHBURN ST
DETROIT MI
48221-3217
US

IV. Provider business mailing address

19137 WASHBURN ST
DETROIT MI
48221-3217
US

V. Phone/Fax

Practice location:
  • Phone: 248-678-1975
  • Fax:
Mailing address:
  • Phone: 248-678-1975
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TANISHA LARAYE MATHIS-OWENS
Title or Position: OWNER/PROGRAM COORDINATOR
Credential: LIFE PRODUCER LICENS
Phone: 248-678-1975