Healthcare Provider Details

I. General information

NPI: 1144199357
Provider Name (Legal Business Name): THE 4EVER HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14395 HENDRICKS AVE
WARREN MI
48089-5469
US

IV. Provider business mailing address

14395 HENDRICKS AVE
WARREN MI
48089-5469
US

V. Phone/Fax

Practice location:
  • Phone: 248-277-6601
  • Fax: 248-277-6601
Mailing address:
  • Phone: 248-277-6601
  • Fax: 248-277-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: TAYA R GRANT
Title or Position: OWNER
Credential:
Phone: 248-277-6601