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General NPI Number Information
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NPI Number | 1487342374
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Entity Type | Organization
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Legal Business Name | EYEWITNESS AT YOUR SERVICE LLC
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 46300 LAKESIDE PARK DR APT 104
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City | SHELBY TWP
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State | MI
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Zip | 48315-5543
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Country | US
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Telephone | 313-753-0389
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Fax | 586-317-6056
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Provider Business Mailing Address
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Address Line | 46300 LAKESIDE PARK DR APT 104
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City | SHELBY TWP
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State | MI
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Zip | 48315-5543
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Country | US
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Telephone | 313-753-0389
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Fax | 586-317-6056
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Authorized Official
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Title or Position | AUTHORIZED REPRESENTATIVE
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Name | ROCHELLE L COADY
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Credential |
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Telephone | 586-477-5458
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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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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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