Healthcare Provider Details

I. General information

NPI: 1679704886
Provider Name (Legal Business Name): EMINENCE HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20061 BENTLER ST
DETROIT MI
48219-1325
US

IV. Provider business mailing address

20061 BENTLER ST
DETROIT MI
48219-1325
US

V. Phone/Fax

Practice location:
  • Phone: 313-778-6868
  • Fax:
Mailing address:
  • Phone: 313-778-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number376K00000X
License Number StateMI

VIII. Authorized Official

Name: MS. ALICIA SHARAIM SMILEY-FULLER
Title or Position: CERTIFIED NURSING ASSISTANT
Credential:
Phone: 313-778-6868