Healthcare Provider Details

I. General information

NPI: 1497269765
Provider Name (Legal Business Name): LOVING CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2017
Last Update Date: 11/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 OAK ST
WYANDOTTE MI
48192-5038
US

IV. Provider business mailing address

524 OAK ST
WYANDOTTE MI
48192-5038
US

V. Phone/Fax

Practice location:
  • Phone: 734-246-0679
  • Fax:
Mailing address:
  • Phone: 734-246-0679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. KENNETH DWAYNE MOORE
Title or Position: OWNER/BUSINESS MANAGER
Credential:
Phone: 734-767-4171