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General NPI Number Information
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NPI Number | 1720874423
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Entity Type | Organization
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Legal Business Name | RANDYS PLACE LLC
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Dates
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Enumeration Date | 04/17/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 5910 LAKEWOOD ST
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City | DETROIT
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State | MI
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Zip | 48213-3639
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Country | US
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Telephone | 313-479-6199
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Fax | 313-391-5799
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Provider Business Mailing Address
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Address Line | 5816 NEWPORT ST
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City | DETROIT
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State | MI
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Zip | 48213-3641
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ENDIA HAWKINS
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Credential | BSN, RN
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Telephone | 313-479-6199
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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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Taxonomy #2
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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