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General NPI Number Information
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NPI Number | 1992359285
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Entity Type | Organization
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Legal Business Name | SUTHERLOND HOMES
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 20499 ILENE
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City | DETROIT
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State | MI
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Zip | 48221
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Country | US
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Telephone | 313-953-5692
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Fax |
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Provider Business Mailing Address
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Address Line | 20499 ILENE
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City | DETROIT
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State | MI
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Zip | 48221
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Country | US
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Telephone | 313-953-5692
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JAMES HENRY TILLMON SR.
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Credential |
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Telephone | 313-953-5692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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