=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679340509
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUEEN B HELPING HANDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2023
-----------------------------------------------------
Last Update Date | 12/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24169 LORETTA AVE
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48091-1732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-378-8955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24169 LORETTA AVE
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48091-1732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-378-8955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRENDA THOMAS ALLEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-378-8955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------