MEDICARE: SUPPORTIVE HOME HEALTH CARE 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	163WI0500X	Infusion Therapy Registered Nurse
2	2251G0304X	Geriatric Physical Therapist
3	225700000X	Massage Therapist
4	225X00000X	Occupational Therapist
5	251E00000X	Home Health Agency	237746	MI
6	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1245745447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPORTIVE HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	32003 PLYMOUTH RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150-1927
Country	:	US
Telephone Number	:	248-291-5806
Fax Number	:	248-281-1016

Provider Business Practice Location Address
First Line	:	32003 PLYMOUTH RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150-1927
Country	:	US
Telephone Number	:	248-291-5806
Fax Number	:	248-281-1016

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MICHAEL MALECKI
Credential	:
Telephone Number	:	248-291-5806

Provider Enumeration Date	:	12/11/2017
Last Update Date	:	06/27/2023

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