=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922353291
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH CONNECTION HOME HEALTH CARE,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2012
-----------------------------------------------------
Last Update Date | 07/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2936 FULLERTON ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48238-3302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-252-8271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2936 FULLERTON ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48238-3302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-252-8271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. GABRIELLA MICHELLE PREWITT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-252-8271
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | D7916W
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------