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General NPI Number Information
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NPI Number | 1053392167
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Entity Type | Organization
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Legal Business Name | MY HOME MD, PLCC
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 28855 VAN DYKE AVE
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City | WARREN
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State | MI
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Zip | 48093-2744
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Country | US
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Telephone | 586-558-9545
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Fax | 586-558-9541
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Provider Business Mailing Address
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Address Line | 28855 VAN DYKE AVE
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City | WARREN
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State | MI
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Zip | 48093-2744
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Country | US
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Telephone | 586-558-9545
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Fax | 586-558-9541
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. WILLIAM H. HAITHCO
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Credential |
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Telephone | 586-558-9545
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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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