Healthcare Provider Details

I. General information

NPI: 1932980463
Provider Name (Legal Business Name): HEART CENTERED HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22725 GREATER MACK AVE # 301B4017
SAINT CLAIR SHORES MI
48080-2023
US

IV. Provider business mailing address

18288 HOLLAND AVE
EASTPOINTE MI
48021-2614
US

V. Phone/Fax

Practice location:
  • Phone: 586-738-0372
  • Fax:
Mailing address:
  • Phone: 586-738-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRIDGETT MATHIS
Title or Position: CEO
Credential:
Phone: 470-798-7563