Healthcare Provider Details

I. General information

NPI: 1720451180
Provider Name (Legal Business Name): INETGRATED ADULT HOME CARE AGENCY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11425 SAINT ALOYSIUS ST
ROMULUS MI
48174-1187
US

IV. Provider business mailing address

11425 SAINT ALOYSIUS ST
ROMULUS MI
48174-1187
US

V. Phone/Fax

Practice location:
  • Phone: 734-635-7044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAS820340264
License Number StateMI

VIII. Authorized Official

Name: MR. TANYI CHARLES AGBOR-BAIYEE
Title or Position: OWNER
Credential:
Phone: 734-635-7044