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General NPI Number Information
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NPI Number | 1679704886
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Entity Type | Organization
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Legal Business Name | EMINENCE HOME HEALTH
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | 20061 BENTLER ST
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City | DETROIT
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State | MI
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Zip | 48219-1325
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Country | US
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Telephone | 313-778-6868
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Fax |
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Provider Business Mailing Address
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Address Line | 20061 BENTLER ST
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City | DETROIT
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State | MI
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Zip | 48219-1325
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Country | US
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Telephone | 313-778-6868
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Fax |
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Authorized Official
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Title or Position | CERTIFIED NURSING ASSISTANT
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Name | MS. ALICIA SHARAIM SMILEY-FULLER
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Credential |
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Telephone | 313-778-6868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 376K00000X
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License Number State | MI
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