Healthcare Provider Details

I. General information

NPI: 1073431292
Provider Name (Legal Business Name): CB SENIOR HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18640 MACK AVE UNIT 36784
GROSSE POINTE FARMS MI
48236-7734
US

IV. Provider business mailing address

18640 MACK AVE UNIT 36784
GROSSE POINTE FARMS MI
48236-7734
US

V. Phone/Fax

Practice location:
  • Phone: 586-459-8679
  • Fax:
Mailing address:
  • Phone: 586-459-8679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management 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: ANDREA LASHA CHARLTON
Title or Position: OWNER
Credential:
Phone: 586-459-8679