Healthcare Provider Details

I. General information

NPI: 1386094340
Provider Name (Legal Business Name): CITY HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17183 GRIGGS ST
DETROIT MI
48221-2426
US

IV. Provider business mailing address

17301 LIVERNOIS AVE STE 929
DETROIT MI
48221-2758
US

V. Phone/Fax

Practice location:
  • Phone: 650-255-4547
  • Fax:
Mailing address:
  • Phone: 650-255-4547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MEGAN BOYLE
Title or Position: DIRECTOR
Credential:
Phone: 650-255-4547