Healthcare Provider Details

I. General information

NPI: 1326856261
Provider Name (Legal Business Name): KARAKUNNEL HOME CARE VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18514 MACK AVE STE 101
GROSSE POINTE FARMS MI
48236-3294
US

IV. Provider business mailing address

10153 1/2 RIVERSIDE DR STE 515
TOLUCA LAKE CA
91602-2561
US

V. Phone/Fax

Practice location:
  • Phone: 818-235-3849
  • Fax:
Mailing address:
  • Phone: 818-235-3849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BEN KARAKUNNEL
Title or Position: MEMBER
Credential:
Phone: 818-235-3849