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General NPI Number Information
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NPI Number | 1154094423
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Entity Type | Organization
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Legal Business Name | DELORES HEAVENLY GATES
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Dates
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Enumeration Date | 07/31/2021
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 20300 SAINT MARYS ST
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City | DETROIT
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State | MI
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Zip | 48235-2177
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Country | US
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Telephone | 734-330-2426
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Fax | 734-356-2426
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Provider Business Mailing Address
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Address Line | 20300 SAINT MARYS ST
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City | DETROIT
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State | MI
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Zip | 48235-2177
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Country | US
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Telephone | 734-330-2426
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Fax | 734-356-3131
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TARA GHOLSON
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Credential |
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Telephone | 313-598-2819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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