Healthcare Provider Details

I. General information

NPI: 1215824297
Provider Name (Legal Business Name): ST. RICHARD'S ANGELS HOME HELP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 06/21/2025
Certification Date: 06/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4233 MARYWOOD DR
TROY MI
48085-3652
US

IV. Provider business mailing address

4233 MARYWOOD DR
TROY MI
48085-3652
US

V. Phone/Fax

Practice location:
  • Phone: 734-239-3310
  • Fax:
Mailing address:
  • Phone: 734-239-3310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. JALISA SHAWNEA SMITH
Title or Position: OWNER
Credential: LPN
Phone: 734-239-3310