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General NPI Number Information
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NPI Number | 1033900154
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Entity Type | Organization
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Legal Business Name | SERVING HEARTS GROUP HOMES II, LLC
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 16184 TRINITY ST
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City | DETROIT
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State | MI
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Zip | 48219-3971
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Country | US
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Telephone | 313-221-4435
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Fax |
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Provider Business Mailing Address
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Address Line | 18708 MANSFIELD ST
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City | DETROIT
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State | MI
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Zip | 48235-2962
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Country | US
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Telephone | 313-221-4435
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SWANMIKA JOHNSON
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Credential | WSU BACHELORS DEGREE
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Telephone | 313-221-4435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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