=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619855293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADELCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2025
-----------------------------------------------------
Last Update Date | 08/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34204 CLINTON PLAZA DR
-----------------------------------------------------
City | CLINTON TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48035-3335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-920-4195
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34204 CLINTON PLAZA DR
-----------------------------------------------------
City | CLINTON TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48035-3335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-920-4195
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRIDGETT MOSS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-920-4195
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------