Healthcare Provider Details

I. General information

NPI: 1710730031
Provider Name (Legal Business Name): RAYS OF IRIS HOME CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21701 W 11 MILE RD STE 8
SOUTHFIELD MI
48076-3713
US

IV. Provider business mailing address

6689 ORCHARD LAKE RD # 142
WEST BLOOMFIELD MI
48322-3404
US

V. Phone/Fax

Practice location:
  • Phone: 248-972-7132
  • Fax: 248-262-6888
Mailing address:
  • Phone: 248-972-7132
  • 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 Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SUMAYAH WAKELY
Title or Position: CEO
Credential:
Phone: 248-972-7132