Healthcare Provider Details

I. General information

NPI: 1073223723
Provider Name (Legal Business Name): UNIQUE HOME OF LOVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17200 E 10 MILE RD STE 270
EASTPOINTE MI
48021-3355
US

IV. Provider business mailing address

17200 E 10 MILE RD STE 270
EASTPOINTE MI
48021-3355
US

V. Phone/Fax

Practice location:
  • Phone: 313-324-2144
  • Fax:
Mailing address:
  • Phone:
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: BRYANNA JACKSON
Title or Position: OWNER
Credential:
Phone: 313-324-2144