MEDICARE: THE H2O AGENCY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1215730619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE H2O AGENCY LLC

Provider Business Mailing Address
First Line	:	19948 KEYSTONE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-2364
Country	:	US
Telephone Number	:	313-624-5375
Fax Number	:

Provider Business Practice Location Address
First Line	:	19948 KEYSTONE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-2364
Country	:	US
Telephone Number	:	313-217-5800
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS CHERYL RENEE MILLER
Credential	:
Telephone Number	:	313-624-5375

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	03/02/2026

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Directions to “THE H2O AGENCY LLC ” Practice Location

Language	Start Address	Practice Location

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