Healthcare Provider Details

I. General information

NPI: 1427201409
Provider Name (Legal Business Name): TANGERINE ROSE HOME HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14148 SALEM
REDFORD MI
48239-2812
US

IV. Provider business mailing address

14148 SALEM
REDFORD MI
48239-2812
US

V. Phone/Fax

Practice location:
  • Phone: 313-766-0496
  • Fax: 313-766-0496
Mailing address:
  • Phone: 313-766-0496
  • Fax: 313-766-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberPENDING
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: MRS. DUOWANA LYNN PEARCY
Title or Position: CEO
Credential: DIRECT CARE STAFFING
Phone: 313-766-0496