Healthcare Provider Details

I. General information

NPI: 1366373607
Provider Name (Legal Business Name): LPH HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MACOMB PL
MOUNT CLEMENS MI
48043-5625
US

IV. Provider business mailing address

25535 ARLINGTON ST
ROSEVILLE MI
48066-3919
US

V. Phone/Fax

Practice location:
  • Phone: 586-252-0088
  • Fax:
Mailing address:
  • Phone: 586-252-0088
  • Fax: 586-252-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DESIRER JACKSON-WILLIAMS
Title or Position: OWNER
Credential: JACKSON-WILLIAMS
Phone: 586-252-0088