Healthcare Provider Details

I. General information

NPI: 1588359822
Provider Name (Legal Business Name): SERVING OTHERS HOME GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15581 NORBORNE
REDFORD MI
48239-3815
US

IV. Provider business mailing address

15581 NORBORNE
REDFORD MI
48239-3815
US

V. Phone/Fax

Practice location:
  • Phone: 947-282-0096
  • Fax:
Mailing address:
  • Phone: 947-282-0096
  • 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 Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: BRENAE RAYBORN
Title or Position: OWNER
Credential: NURSE ASSISTANT
Phone: 947-282-0096