Healthcare Provider Details

I. General information

NPI: 1710553839
Provider Name (Legal Business Name): MIBELL HOME HEALTH CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2021
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28986 SUGAR ISLAND CT
GIBRALTAR MI
48173-9578
US

IV. Provider business mailing address

28986 SUGAR ISLAND CT
GIBRALTAR MI
48173-9578
US

V. Phone/Fax

Practice location:
  • Phone: 248-929-4645
  • Fax:
Mailing address:
  • Phone: 248-929-4645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State

VIII. Authorized Official

Name: BRITTIANEE PETTAWAY
Title or Position: OWNER
Credential:
Phone: 248-929-4645