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General NPI Number Information
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NPI Number | 1326843715
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Entity Type | Organization
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Legal Business Name | LAUNDREA WILLIS
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 636 E KIRBY ST
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City | DETROIT
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State | MI
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Zip | 48202-4123
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Country | US
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Telephone | 313-600-6301
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Fax |
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Provider Business Mailing Address
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Address Line | 4032 E OUTER DR
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City | DETROIT
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State | MI
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Zip | 48234-2921
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Country | US
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Telephone | 313-707-9889
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAUNDREA ELMIRA WILLLIS
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Credential |
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Telephone | 313-707-9889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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