Healthcare Provider Details

I. General information

NPI: 1659192805
Provider Name (Legal Business Name): ST CHRISTOPHERS PRIVATE HOME HEALTHCARE AGENCY OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15012 PENROD ST
DETROIT MI
48223-2337
US

IV. Provider business mailing address

25552 SHIAWASSEE RD APT 521
SOUTHFIELD MI
48033-3708
US

V. Phone/Fax

Practice location:
  • Phone: 623-277-7828
  • Fax:
Mailing address:
  • Phone: 513-237-8346
  • 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: PAULA LORRAINE HESTER
Title or Position: CEO/HEALTHCARE DIRECTOR
Credential:
Phone: 623-277-7828