Healthcare Provider Details

I. General information

NPI: 1902124530
Provider Name (Legal Business Name): FAIRLANE HOME HEALTH CARE AGENCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14847 GRATIOT AVE SUITE A
DETROIT MI
48205-1942
US

IV. Provider business mailing address

14847 GRATIOT AVE STE A
DETROIT MI
48205-1942
US

V. Phone/Fax

Practice location:
  • Phone: 313-588-2403
  • Fax:
Mailing address:
  • Phone: 313-588-2403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TALAL H SABRAH
Title or Position: PRESIDENT
Credential:
Phone: 313-588-2403