Healthcare Provider Details

I. General information

NPI: 1417579376
Provider Name (Legal Business Name): AH TROY SUBTENANT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 GRAND HAVEN DR
TROY MI
48083-4418
US

IV. Provider business mailing address

2300 GRAND HAVEN DR
TROY MI
48083-4418
US

V. Phone/Fax

Practice location:
  • Phone: 248-589-3555
  • Fax: 248-589-9949
Mailing address:
  • Phone: 248-589-3555
  • Fax: 248-589-9949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 248-589-3555