Healthcare Provider Details

I. General information

NPI: 1457047839
Provider Name (Legal Business Name): BROOKHAVEN HOUSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9372 PINEHURST ST
DETROIT MI
48204-2658
US

IV. Provider business mailing address

31749 HAZELWOOD ST
WESTLAND MI
48186-8933
US

V. Phone/Fax

Practice location:
  • Phone: 734-674-2128
  • Fax:
Mailing address:
  • Phone: 313-704-4207
  • 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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARCEIA LEWIS
Title or Position: OWNER
Credential: RN
Phone: 734-674-2128