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General NPI Number Information
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NPI Number | 1629763982
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Entity Type | Organization
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Legal Business Name | METRO PRESTIGIOUS HOME SERVICES LLC
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 04/11/2023
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Provider Practice Location Address
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Address Line | 17520 W 12 MILE RD # 206
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City | SOUTHFIELD
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State | MI
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Zip | 48076-1945
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Country | US
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Telephone | 248-929-2930
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Fax |
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Provider Business Mailing Address
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Address Line | 25535 CATALINA ST # A
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City | SOUTHFIELD
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State | MI
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Zip | 48075-1774
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Country | US
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Telephone | 249-929-2930
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Fax |
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | TATIANNA D TYE
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Credential | LPN
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Telephone | 249-929-2930
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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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