Healthcare Provider Details

I. General information

NPI: 1285456418
Provider Name (Legal Business Name): HARLEYS HART HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17520 W 12 MILE RD STE 109
SOUTHFIELD MI
48076-1907
US

IV. Provider business mailing address

25535 CATALINA ST
SOUTHFIELD MI
48075-1774
US

V. Phone/Fax

Practice location:
  • Phone: 248-929-2930
  • Fax:
Mailing address:
  • Phone: 248-929-2930
  • Fax:

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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TATIANNA TYE
Title or Position: OWNER
Credential:
Phone: 248-929-2930