Healthcare Provider Details

I. General information

NPI: 1295428258
Provider Name (Legal Business Name): DOMINION STAFFING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24655 SOUTHFIELD RD STE 104
SOUTHFIELD MI
48075-8100
US

IV. Provider business mailing address

24655 SOUTHFIELD RD STE 104
SOUTHFIELD MI
48075-8100
US

V. Phone/Fax

Practice location:
  • Phone: 313-888-5097
  • Fax:
Mailing address:
  • Phone: 313-888-5097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: BOBBY L FESTUS
Title or Position: OWNER
Credential:
Phone: 313-888-5097