Healthcare Provider Details

I. General information

NPI: 1134305824
Provider Name (Legal Business Name): SELECT COMFORT HOME HEALTHCARE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22821 MANISTEE STREET
OAK PARK MI
48237-2971
US

IV. Provider business mailing address

PO BOX 231141
DETROIT MI
48223-9141
US

V. Phone/Fax

Practice location:
  • Phone: 248-547-5002
  • Fax:
Mailing address:
  • Phone: 248-547-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number2300010147770804
License Number StateMI

VIII. Authorized Official

Name: MS. TAMIKA TENNETTE THOMAS
Title or Position: CERTIFIED NURSE ASSISTANT
Credential: CENA
Phone: 248-547-5002