=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174096689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUMANISTIC CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2019
-----------------------------------------------------
Last Update Date | 07/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23332 FARMINGTON RD SUITE 802
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48336-2332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-747-1396
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24062 MERRILYN CT
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48336-2332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-747-1396
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING EMPLOYEE
-----------------------------------------------------
Name | LAQUISHA BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-747-1396
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------