Healthcare Provider Details

I. General information

NPI: 1801326699
Provider Name (Legal Business Name): LOVING HEARTS FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24110 OUTER DR
MELVINDALE MI
48122-1644
US

IV. Provider business mailing address

PO BOX 37618
OAK PARK MI
48237-0618
US

V. Phone/Fax

Practice location:
  • Phone: 248-670-9787
  • Fax: 248-670-9787
Mailing address:
  • Phone: 248-670-9787
  • Fax: 248-808-6944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ZAD THOMAS WHITE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 248-670-9787