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General NPI Number Information
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NPI Number | 1760771430
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Entity Type | Organization
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Legal Business Name | MISSION HOME HEALTH CARE, LLC
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 12/28/2012
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Provider Practice Location Address
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Address Line | 5820 N LILLEY RD SUITE 5
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City | CANTON
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State | MI
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Zip | 48187-3686
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Country | US
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Telephone | 734-335-6393
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Fax | 734-335-6774
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Provider Business Mailing Address
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Address Line | 5820 N LILLEY RD SUITE 5
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City | CANTON
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State | MI
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Zip | 48187-3686
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Country | US
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Telephone | 734-335-6393
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Fax | 734-335-6774
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. DOMINIQUE B. SULLANO
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Credential |
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Telephone | 734-968-4341
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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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