Healthcare Provider Details

I. General information

NPI: 1275110538
Provider Name (Legal Business Name): KEHLANI CARES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 15TH ST
WYANDOTTE MI
48192-3616
US

IV. Provider business mailing address

14000 DIX TOLEDO RD UNIT 1311
SOUTHGATE MI
48195-9513
US

V. Phone/Fax

Practice location:
  • Phone: 734-307-5378
  • Fax: 734-638-6005
Mailing address:
  • Phone: 734-307-5378
  • Fax: 734-638-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRACY D FUENTES
Title or Position: OWNER
Credential:
Phone: 734-307-5378