Healthcare Provider Details

I. General information

NPI: 1952177156
Provider Name (Legal Business Name): PURPLE WINGS HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16840 WOODBINE ST
DETROIT MI
48219-3742
US

IV. Provider business mailing address

16840 WOODBINE ST
DETROIT MI
48219-3742
US

V. Phone/Fax

Practice location:
  • Phone: 313-728-7749
  • Fax:
Mailing address:
  • Phone: 313-728-7749
  • 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
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. CRYSTAL L COOK
Title or Position: ADMINISTRATION CONSULTANT
Credential:
Phone: 313-728-7749