=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083104095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOOK@FAITH INC. HOMECARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2018
-----------------------------------------------------
Last Update Date | 08/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24209 NORTHWESTERN HWY STE 208
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48075-2570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-444-4081
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29488 WOODWARD AVE STE 458
-----------------------------------------------------
City | ROYAL OAK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48073-0903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-890-0098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. SHANNON JACKSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 734-890-0098
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------