Healthcare Provider Details

I. General information

NPI: 1528342698
Provider Name (Legal Business Name): LOUELLA'S LOVING HANDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16246 S M 52
STOCKBRIDGE MI
49285-9592
US

IV. Provider business mailing address

PO BOX 981113
YPSILANTI MI
48198-1113
US

V. Phone/Fax

Practice location:
  • Phone: 180-038-5188
  • Fax: 188-868-4076
Mailing address:
  • Phone: 180-038-5188
  • Fax: 188-868-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LAKIESHA ANICE JACKSON
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 734-657-8576