Healthcare Provider Details

I. General information

NPI: 1174453385
Provider Name (Legal Business Name): CHARLA ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26400 W 8 MILE RD STE 207
SOUTHFIELD MI
48033-5980
US

IV. Provider business mailing address

26400 W 8 MILE RD STE 207
SOUTHFIELD MI
48033-5980
US

V. Phone/Fax

Practice location:
  • Phone: 586-625-2161
  • Fax:
Mailing address:
  • Phone: 586-625-2161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License Number
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code331L00000X
TaxonomyBlood Bank
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: