Healthcare Provider Details

I. General information

NPI: 1962254920
Provider Name (Legal Business Name): MEADOW OAKS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21601 CLOVERLAWN ST
OAK PARK MI
48237-2630
US

IV. Provider business mailing address

21601 CLOVERLAWN ST
OAK PARK MI
48237-2630
US

V. Phone/Fax

Practice location:
  • Phone: 131-360-5608
  • Fax:
Mailing address:
  • Phone: 313-605-6080
  • Fax:

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: AKILIA WELLS-JACKSON
Title or Position: OWNER/RN
Credential: RN
Phone: 313-626-0220