Healthcare Provider Details

I. General information

NPI: 1306888714
Provider Name (Legal Business Name): PERSONALIZE HOME CARE SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28021 SOUTHFIELD RD STE 200
LATHRUP VILLAGE MI
48076-2816
US

IV. Provider business mailing address

28021 SOUTHFIELD RD STE 200
LATHRUP VILLAGE MI
48076-2816
US

V. Phone/Fax

Practice location:
  • Phone: 248-621-1111
  • Fax: 248-621-2222
Mailing address:
  • Phone: 248-621-1111
  • Fax: 248-621-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARLON ARTHUR BURT
Title or Position: VICE PRESIDENT
Credential:
Phone: 248-621-1111