Healthcare Provider Details

I. General information

NPI: 1255822748
Provider Name (Legal Business Name): THE G MCCOY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29551 GREENFIELD RD STE 213
SOUTHFIELD MI
48076-5872
US

IV. Provider business mailing address

29551 GREENFIELD RD STE 213
SOUTHFIELD MI
48076-5872
US

V. Phone/Fax

Practice location:
  • Phone: 248-281-3299
  • Fax: 248-281-3585
Mailing address:
  • Phone: 248-281-3299
  • Fax: 248-281-3585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. AISHA MCCOY
Title or Position: CEO
Credential:
Phone: 248-281-3299