Healthcare Provider Details

I. General information

NPI: 1790148641
Provider Name (Legal Business Name): CGM HOME HEALTHCARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17356 W 12 MILE RD STE 202
SOUTHFIELD MI
48076-6316
US

IV. Provider business mailing address

17356 W 12 MILE RD STE 202
SOUTHFIELD MI
48076-6316
US

V. Phone/Fax

Practice location:
  • Phone: 248-809-9791
  • Fax: 313-270-7291
Mailing address:
  • Phone: 248-809-9791
  • Fax: 313-270-7291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number4704256997
License Number StateMI

VIII. Authorized Official

Name: MR. JEAN FELIX NYAMBIO
Title or Position: PRESIDENT
Credential: CRNA
Phone: 248-809-9791