Healthcare Provider Details

I. General information

NPI: 1053130450
Provider Name (Legal Business Name): COMPANION CARE PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1938 BURDETTE ST STE 1
FERNDALE MI
48220-1982
US

IV. Provider business mailing address

535 GRISWOLD ST STE 111-540
DETROIT MI
48226-3604
US

V. Phone/Fax

Practice location:
  • Phone: 313-471-8407
  • Fax:
Mailing address:
  • Phone: 313-471-8407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. ROBERT L BARKSDALE
Title or Position: OWNER
Credential:
Phone: 313-471-8407