=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992127104
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY EMBRACE HOME HEALTH AGENCY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2014
-----------------------------------------------------
Last Update Date | 01/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24725 W 12 MILE RD STE 120
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48034-1801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-371-0561
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24725 W 12 MILE RD STE 120
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48034-1801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-371-0561
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. DIQUITA KARVA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-371-0561
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 4704218369
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------