Healthcare Provider Details

I. General information

NPI: 1003472598
Provider Name (Legal Business Name): CORPORE SANO HOME HEALTH CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39475 ANN ARBOR RD E
PLYMOUTH MI
48170-4524
US

IV. Provider business mailing address

39475 ANN ARBOR RD E
PLYMOUTH MI
48170-4524
US

V. Phone/Fax

Practice location:
  • Phone: 734-454-3488
  • Fax: 734-454-3599
Mailing address:
  • Phone: 734-454-3488
  • Fax: 734-454-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MIHAELA BRAZDAU
Title or Position: OWNER
Credential:
Phone: 734-454-3488