=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689537946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRANNY'S HELPERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16129 W MCNICHOLS ROAD
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-370-7894
-----------------------------------------------------
Fax | 231-216-7861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16129 W MCNICHOLS ROAD
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-370-7849
-----------------------------------------------------
Fax | 231-216-7861
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHLEBOTIMIST
-----------------------------------------------------
Name | JIMIA STARR GREEN
-----------------------------------------------------
Credential | PHLEBOTOMY
-----------------------------------------------------
Telephone | 313-370-7894
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 202K00000X
-----------------------------------------------------
Taxonomy Name | Phlebology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------