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General NPI Number Information
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NPI Number | 1124803275
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Entity Type | Organization
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Legal Business Name | LONG LIFE HOME HEALTH SERVICES LLC
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 28051 DEQUINDRE RD STE E
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-3016
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Country | US
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Telephone | 248-443-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 28051 DEQUINDRE RD STE E
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-3016
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAOTH SHAKER-SALAM ABDELMALEK
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Credential |
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Telephone | 248-790-0700
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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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