Healthcare Provider Details

I. General information

NPI: 1952092496
Provider Name (Legal Business Name): HEAVENLY HANDS COMMUNITY HELP GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 TOWN CTR STE 1900
SOUTHFIELD MI
48075-1152
US

IV. Provider business mailing address

2000 TOWN CTR STE 1900
SOUTHFIELD MI
48075-1152
US

V. Phone/Fax

Practice location:
  • Phone: 248-801-2011
  • Fax:
Mailing address:
  • Phone: 248-801-2011
  • 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 Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: JATIA SYLVESTER
Title or Position: OWNER
Credential:
Phone: 248-801-2011