MEDICARE: XAVIER LEGACY 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1700724143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	XAVIER LEGACY HOME HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	14912 EASTBURN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-1311
Country	:	US
Telephone Number	:	313-421-5368
Fax Number	:

Provider Business Practice Location Address
First Line	:	14912 EASTBURN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-1311
Country	:	US
Telephone Number	:	313-421-5368
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER & DIRECTOR
Name	:	JADE MATTHEWS
Credential	:
Telephone Number	:	313-421-5368

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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