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General NPI Number Information
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NPI Number | 1093585929
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Entity Type | Organization
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Legal Business Name | ELENA HEARTS OF BLESS HANDS LLC
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 3600 14TH ST APT 202
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City | DETROIT
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State | MI
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Zip | 48208-2685
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Country | US
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Telephone | 313-296-6155
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 14TH ST APT 202
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City | DETROIT
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State | MI
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Zip | 48208-2685
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Country | US
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Telephone | 313-296-6155
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Fax |
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Authorized Official
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Title or Position | OWNER/NURSING ASSISTANT
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Name | MAREKA DAVEY-FORTSON
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Credential | CNA
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Telephone | 313-296-6155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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