Healthcare Provider Details

I. General information

NPI: 1851209316
Provider Name (Legal Business Name): DYNAMIC HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30431 VENTURA ST
SOUTHFIELD MI
48076-1215
US

IV. Provider business mailing address

28475 GREENFIELD RD # 110
SOUTHFIELD MI
48076-3034
US

V. Phone/Fax

Practice location:
  • Phone: 248-514-0975
  • Fax:
Mailing address:
  • Phone: 248-514-0975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: ANISHA L JORDAN
Title or Position: EXECUTIVE DIRECTOR
Credential: LICENSED AFC HOME PR
Phone: 248-514-0975