MEDICARE: TAYLOR-MADE HOME 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1306190699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAYLOR-MADE HOME CARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 35056
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-0056
Country	:	US
Telephone Number	:	888-507-2003
Fax Number	:	888-507-2003

Provider Business Practice Location Address
First Line	:	16745 MURRAY HILL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3639
Country	:	US
Telephone Number	:	313-989-7624
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. TATRINA MARNITA HOWARD
Credential	:	BSHA
Telephone Number	:	313-989-7624

Provider Enumeration Date	:	11/08/2012
Last Update Date	:	03/28/2014

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