=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861360604
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PETERS HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2025
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29244 OAK POINT DR
-----------------------------------------------------
City | FARMINGTON HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48331-2773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-556-2700
-----------------------------------------------------
Fax | 586-556-2700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29244 OAK POINT DR
-----------------------------------------------------
City | FARMINGTON HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48331-2773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-556-2700
-----------------------------------------------------
Fax | 586-556-2700
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MICHAEL J TELLOW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 586-556-2700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------