Healthcare Provider Details

I. General information

NPI: 1215744388
Provider Name (Legal Business Name): HARVEST HOME CARE AGENCY LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 WENDOVER BLVD
NORTON SHORES MI
49441-5053
US

IV. Provider business mailing address

851 WENDOVER BLVD
NORTON SHORES MI
49441-5053
US

V. Phone/Fax

Practice location:
  • Phone: 248-298-9215
  • Fax:
Mailing address:
  • Phone: 248-298-9215
  • 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: MELLANIE KNOX
Title or Position: OWNER
Credential:
Phone: 248-298-9215