Healthcare Provider Details

I. General information

NPI: 1053739599
Provider Name (Legal Business Name): AHAVA CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14840 BORGMAN ST
OAK PARK MI
48237-1061
US

IV. Provider business mailing address

14840 BORGMAN ST
OAK PARK MI
48237-1061
US

V. Phone/Fax

Practice location:
  • Phone: 248-542-5197
  • Fax: 270-738-8282
Mailing address:
  • Phone: 248-259-8546
  • Fax: 270-738-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PAMELA D SOLOWAY
Title or Position: OWNER
Credential:
Phone: 248-259-8546