Healthcare Provider Details

I. General information

NPI: 1124956859
Provider Name (Legal Business Name): CHARLOTTE TANESHA RHODEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15900 W 10 MILE RD
SOUTHFIELD MI
48075-2036
US

IV. Provider business mailing address

15900 W 10 MILE RD # 129
SOUTHFIELD MI
48075-2036
US

V. Phone/Fax

Practice location:
  • Phone: 248-915-1899
  • Fax:
Mailing address:
  • Phone: 248-915-1899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2026050000256
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number202605000256
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: