=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245420504
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLASSIC HOME CARE-LIVINGSTON, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2007
-----------------------------------------------------
Last Update Date | 10/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 W NORTH ST SUITE 4
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48116-1572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-229-2271
-----------------------------------------------------
Fax | 810-229-7277
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 W NORTH ST SUITE 4
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48116-1572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-229-2271
-----------------------------------------------------
Fax | 810-229-7277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MS. NEELAM GUGLANI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 810-229-2271
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------