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General NPI Number Information
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NPI Number | 1265250351
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Entity Type | Organization
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Legal Business Name | MONTGOMERY FAMILY CARE LLC
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Dates
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Enumeration Date | 09/28/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 2785 E GRAND BLVD UNIT 169
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City | DETROIT
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State | MI
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Zip | 48211-2003
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Country | US
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Telephone | 248-919-8388
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Fax |
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Provider Business Mailing Address
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Address Line | 43313 WOODWARD AVE # 1451
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-5007
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Country | US
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Telephone | 248-919-8388
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Fax |
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Authorized Official
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Title or Position | CEO & OWNER
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Name | JEANNA MONTGOMERY
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Credential |
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Telephone | 248-919-8333
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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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