Healthcare Provider Details

I. General information

NPI: 1619255700
Provider Name (Legal Business Name): EXTENDED HANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2011
Last Update Date: 07/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 BLUEHILL ST
DETROIT MI
48224-2232
US

IV. Provider business mailing address

3970 BLUEHILL ST
DETROIT MI
48224-2232
US

V. Phone/Fax

Practice location:
  • Phone: 313-925-6666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name: AISHA AMANDA CRENSHAW
Title or Position: OWNER/PARTNER
Credential:
Phone: 313-925-6666