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General NPI Number Information
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NPI Number | 1124814793
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Entity Type | Organization
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Legal Business Name | BERTHA HOME CARE
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 24255 LATHRUP BLVD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2838
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Country | US
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Telephone | 248-667-6730
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Fax |
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Provider Business Mailing Address
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Address Line | 29488 WOODWARD AVE # 186
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City | ROYAL OAK
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State | MI
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Zip | 48073-0903
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Country | US
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Telephone | 248-667-6730
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. MICHAEL O TAIT
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Credential |
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Telephone | 248-667-6730
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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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