MEDICARE: KALI HOME HELP AND 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1689498578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALI HOME HELP AND HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	13206 WESTLAKE CIR BLDG 13
Second Line	:
City	:	VAN BUREN TOWNSHIP
State	:	MI
Zip	:	48111-6137
Country	:	US
Telephone Number	:	248-705-0863
Fax Number	:

Provider Business Practice Location Address
First Line	:	13206 WESTLAKE CIR BLDG 13
Second Line	:
City	:	VAN BUREN TOWNSHIP
State	:	MI
Zip	:	48111-6137
Country	:	US
Telephone Number	:	248-705-0863
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CONSTANCE ELLEN BROWN
Credential	:	LBSW, MBA
Telephone Number	:	734-612-6022

Provider Enumeration Date	:	11/08/2024
Last Update Date	:	11/27/2024

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