Healthcare Provider Details

I. General information

NPI: 1649021494
Provider Name (Legal Business Name): MRS. KANISHA ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 03/29/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28401 MOUND RD UNIT 5390
WARREN MI
48090-7287
US

IV. Provider business mailing address

28401 MOUND RD UNIT 5390
WARREN MI
48090-7287
US

V. Phone/Fax

Practice location:
  • Phone: 586-382-3646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: