Healthcare Provider Details

I. General information

NPI: 1689490559
Provider Name (Legal Business Name): LSJ FAMILY VILLAGE CARE TEAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24634 5 MILE RD STE 19
REDFORD MI
48239-3667
US

IV. Provider business mailing address

24634 5 MILE RD STE 19
REDFORD MI
48239-3667
US

V. Phone/Fax

Practice location:
  • Phone: 877-742-6833
  • Fax:
Mailing address:
  • Phone: 877-742-6833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name: LADAWN JONES-RICHARDSON
Title or Position: DIRECTOR
Credential:
Phone: 877-742-6833