Healthcare Provider Details

I. General information

NPI: 1578817417
Provider Name (Legal Business Name): HOME HELPERS COMPANION AGENCY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E. MAIN ST.
MARION MI
49665
US

IV. Provider business mailing address

PO BOX 332
MARION MI
49665-0332
US

V. Phone/Fax

Practice location:
  • Phone: 231-908-9100
  • Fax:
Mailing address:
  • Phone: 231-908-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. KRISTY J ELLSWORTH
Title or Position: CEO
Credential:
Phone: 231-908-9100