Healthcare Provider Details

I. General information

NPI: 1790697266
Provider Name (Legal Business Name): TAMEKIA HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 LOWCROFT AVE
LANSING MI
48910-5394
US

IV. Provider business mailing address

3090 BOSTEDOR RD
EATON RAPIDS MI
48827-9028
US

V. Phone/Fax

Practice location:
  • Phone: 517-505-6218
  • Fax:
Mailing address:
  • Phone: 517-505-6218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: