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General NPI Number Information
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NPI Number | 1639938491
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Entity Type | Organization
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Legal Business Name | HOMESELEVEN
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Dates
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Enumeration Date | 03/15/2024
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 3317 S GREYFRIAR ST
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City | DETROIT
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State | MI
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Zip | 48217-1038
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Country | US
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Telephone | 313-477-1615
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Fax |
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Provider Business Mailing Address
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Address Line | 672 FAIRWOOD ST
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City | INKSTER
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State | MI
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Zip | 48141-1229
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Country | US
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Telephone | 313-477-1615
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LECHELL THEALINE HUDSON
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Credential |
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Telephone | 313-477-1615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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