Healthcare Provider Details

I. General information

NPI: 1851917538
Provider Name (Legal Business Name): COLONIAL HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27680 FRANKLIN RD # B
SOUTHFIELD MI
48034-8203
US

IV. Provider business mailing address

27680 FRANKLIN RD # B
SOUTHFIELD MI
48034-8203
US

V. Phone/Fax

Practice location:
  • Phone: 248-770-3116
  • Fax: 248-281-1810
Mailing address:
  • Phone: 248-770-3116
  • Fax: 248-281-1810

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

VIII. Authorized Official

Name: ANTHONY RENFROE
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 313-753-5258