Healthcare Provider Details

I. General information

NPI: 1104719244
Provider Name (Legal Business Name): ASSISTED CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4514 FOREST EDGE LN
WEST BLOOMFIELD MI
48323-2182
US

IV. Provider business mailing address

4514 FOREST EDGE LN
WEST BLOOMFIELD MI
48323-2182
US

V. Phone/Fax

Practice location:
  • Phone: 248-761-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: CALVIN PATTAH
Title or Position: MANAGER
Credential:
Phone: 248-761-9800