Healthcare Provider Details

I. General information

NPI: 1437026069
Provider Name (Legal Business Name): HUMBLE HEARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11942 ROSSITER ST
DETROIT MI
48224-1107
US

IV. Provider business mailing address

11942 ROSSITER ST
DETROIT MI
48224-1107
US

V. Phone/Fax

Practice location:
  • Phone: 313-258-3700
  • Fax:
Mailing address:
  • Phone: 313-258-3700
  • 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 Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY M HASSAN
Title or Position: PROVIDER
Credential:
Phone: 313-258-3700