Healthcare Provider Details

I. General information

NPI: 1659629996
Provider Name (Legal Business Name): GLADWELL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18503 LAUREL DR
LIVONIA MI
48152-2998
US

IV. Provider business mailing address

PO BOX 530181
LIVONIA MI
48153-0181
US

V. Phone/Fax

Practice location:
  • Phone: 248-924-8053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SARA FAITH HEDDEN
Title or Position: OWNER
Credential:
Phone: 248-924-8053