Healthcare Provider Details

I. General information

NPI: 1790075240
Provider Name (Legal Business Name): EXPRESS HOME DELIVERIES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25962 NORFOLK ST
INKSTER MI
48141-2432
US

IV. Provider business mailing address

PO BOX 217
INKSTER MI
48141-0217
US

V. Phone/Fax

Practice location:
  • Phone: 313-953-4388
  • Fax: 313-908-2435
Mailing address:
  • Phone: 313-953-4388
  • Fax: 313-908-2435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateMI

VIII. Authorized Official

Name: MS. TIFFANY LARAINE GREEN
Title or Position: OWNER
Credential:
Phone: 313-953-4388