Healthcare Provider Details

I. General information

NPI: 1689208605
Provider Name (Legal Business Name): GEPPETTO'S HEART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24555 SOUTHFIELD RD STE 100
SOUTHFIELD MI
48075-2788
US

IV. Provider business mailing address

24555 SOUTHFIELD RD STE 100
SOUTHFIELD MI
48075-2788
US

V. Phone/Fax

Practice location:
  • Phone: 248-809-3795
  • Fax: 248-327-4286
Mailing address:
  • Phone: 248-809-3795
  • Fax: 248-327-4286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MELVIE TORA BERKERY
Title or Position: DIRECTOR
Credential:
Phone: 313-595-5772