Healthcare Provider Details

I. General information

NPI: 1881072221
Provider Name (Legal Business Name): PROVIDING HEARTS HOME HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 TOWN CTR SUITE 1900
SOUTHFIELD MI
48075-1135
US

IV. Provider business mailing address

2000 TOWN CENTER STE 1900
SOUTHFIELD MI
48075-1152
US

V. Phone/Fax

Practice location:
  • Phone: 248-790-0039
  • Fax:
Mailing address:
  • Phone: 248-790-0039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. JAMAL C JAMES
Title or Position: MEMBER/MANAGER
Credential:
Phone: 248-790-0039