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General NPI Number Information
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NPI Number | 1134305824
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Entity Type | Organization
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Legal Business Name | SELECT COMFORT HOME HEALTHCARE SERVICE
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 22821 MANISTEE STREET
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City | OAK PARK
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State | MI
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Zip | 48237-2971
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Country | US
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Telephone | 248-547-5002
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 231141
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City | DETROIT
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State | MI
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Zip | 48223-9141
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Country | US
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Telephone | 248-547-5002
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Fax |
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Authorized Official
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Title or Position | CERTIFIED NURSE ASSISTANT
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Name | MS. TAMIKA TENNETTE THOMAS
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Credential | CENA
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Telephone | 248-547-5002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 2300010147770804
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License Number State | MI
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