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General NPI Number Information
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NPI Number | 1053130450
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Entity Type | Organization
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Legal Business Name | COMPANION CARE PROVIDERS LLC
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 1938 BURDETTE ST STE 1
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City | FERNDALE
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State | MI
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Zip | 48220-1982
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Country | US
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Telephone | 313-471-8407
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Fax |
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Provider Business Mailing Address
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Address Line | 535 GRISWOLD ST STE 111-540
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City | DETROIT
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State | MI
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Zip | 48226-3604
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Country | US
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Telephone | 313-471-8407
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT L BARKSDALE
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Credential |
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Telephone | 313-471-8407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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