=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043492150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE ESSENTIALS HOME HEALTH CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2007
-----------------------------------------------------
Last Update Date | 11/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 615 GRISWOLD ST STE 1712
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48226-3990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-962-2996
-----------------------------------------------------
Fax | 313-962-2997
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 524 FOX HILLS DR S
-----------------------------------------------------
City | BLOOMFIELD HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48304-1316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-335-0827
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR OF NURSING
-----------------------------------------------------
Name | MS. ANGELA KATRINA HOWARD
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 313-999-4201
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 4704231527
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------