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General NPI Number Information
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NPI Number | 1558519702
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Entity Type | Organization
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Legal Business Name | PROMED HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 08/29/2008
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 330 E 12 MILE RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-2531
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Country | US
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Telephone | 248-629-4100
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Fax | 248-629-4101
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Provider Business Mailing Address
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Address Line | 330 E 12 MILE RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-2531
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Country | US
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Telephone | 248-629-4100
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Fax | 248-629-4101
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIPTI DIVE
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Credential | P.T.
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Telephone | 248-629-4100
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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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