Healthcare Provider Details

I. General information

NPI: 1679739122
Provider Name (Legal Business Name): HOME MDS L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17880 FARMINGTON RD UNIT B
LIVONIA MI
48152-3104
US

IV. Provider business mailing address

17880 FARMINGTON RD UNIT B
LIVONIA MI
48152-3104
US

V. Phone/Fax

Practice location:
  • Phone: 734-744-8560
  • Fax: 734-744-8563
Mailing address:
  • Phone: 734-744-8560
  • Fax: 734-744-8563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number36977
License Number StateMI

VIII. Authorized Official

Name: DR. FANNY AGUIRRE DELA CRUZ
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: M.D.
Phone: 734-744-8560