Healthcare Provider Details

I. General information

NPI: 1477799443
Provider Name (Legal Business Name): BLESSED ANGELS HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26652 TOM ALLEN DR
WARREN MI
48089-3524
US

IV. Provider business mailing address

26652 TOM ALLEN DR
WARREN MI
48089-3524
US

V. Phone/Fax

Practice location:
  • Phone: 313-632-1695
  • Fax: 313-305-4487
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: MISS SHA'JUAN ANITA TAYLOR
Title or Position: MANAGING OWNER
Credential:
Phone: 313-632-1695