Healthcare Provider Details

I. General information

NPI: 1174005227
Provider Name (Legal Business Name): CISSERI HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28931 W 11 MILE RD
FARMINGTON HILLS MI
48336
US

IV. Provider business mailing address

28931 W 11 MILE RD
FARMINGTON HILLS MI
48336-1403
US

V. Phone/Fax

Practice location:
  • Phone: 313-932-2163
  • Fax:
Mailing address:
  • Phone: 313-932-2163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704240894
License Number StateMI

VIII. Authorized Official

Name: SARAH KIRONDE
Title or Position: DIRECTOR
Credential: FNP-BC
Phone: 313-932-2163