Healthcare Provider Details

I. General information

NPI: 1275261364
Provider Name (Legal Business Name): 360 HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15226 S TELEGRAPH RD
MONROE MI
48161-4064
US

IV. Provider business mailing address

206 MARENGO DR
TEMPERANCE MI
48182-9334
US

V. Phone/Fax

Practice location:
  • Phone: 419-290-2264
  • Fax:
Mailing address:
  • Phone: 419-344-8919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MEGHANNE DECANT
Title or Position: OWNER
Credential:
Phone: 419-344-8919