Healthcare Provider Details

I. General information

NPI: 1114836921
Provider Name (Legal Business Name): CHANDLER HOME SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15263 PARK GROVE ST
DETROIT MI
48205-3042
US

IV. Provider business mailing address

15263 PARK GROVE ST
DETROIT MI
48205-3042
US

V. Phone/Fax

Practice location:
  • Phone: 313-607-8083
  • Fax:
Mailing address:
  • Phone: 313-607-8083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHANEL SIMONE CHANDLER
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential:
Phone: 313-607-8083