Healthcare Provider Details

I. General information

NPI: 1245745447
Provider Name (Legal Business Name): SUPPORTIVE HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32003 PLYMOUTH RD
LIVONIA MI
48150-1927
US

IV. Provider business mailing address

32003 PLYMOUTH RD
LIVONIA MI
48150-1927
US

V. Phone/Fax

Practice location:
  • Phone: 248-291-5806
  • Fax: 248-281-1016
Mailing address:
  • Phone: 248-291-5806
  • Fax: 248-281-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number237746
License Number StateMI

VIII. Authorized Official

Name: MICHAEL MALECKI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 248-291-5806