MEDICARE: ST. MARY HOME HEALTH SERVICES 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1386946564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARY HOME HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	28051 DEQUINDRE RD STE B
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-3016
Country	:	US
Telephone Number	:	248-291-5921
Fax Number	:	248-291-5936

Provider Business Practice Location Address
First Line	:	28051 DEQUINDRE RD STE B
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-3016
Country	:	US
Telephone Number	:	248-291-5921
Fax Number	:	248-291-5936

Authorized Official
Title or Position	:	OWNER
Name	:	DINA KAMAL ASMAR
Credential	:
Telephone Number	:	619-402-7927

Provider Enumeration Date	:	11/22/2010
Last Update Date	:	01/11/2022

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