MEDICARE: COMPLETELY LAVISHH STAFFING 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	:	1336926229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETELY LAVISHH STAFFING LLC

Provider Business Mailing Address
First Line	:	2447 HALSTEAD DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-1896
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12725 VIRGIL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-3088
Country	:	US
Telephone Number	:	248-801-2198
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MONIQUE WILLIAMS
Credential	:	RN
Telephone Number	:	248-801-2198

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	09/13/2023

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