MEDICARE: MIA HANCOCK

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1770079584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA HANCOCK

Provider Business Mailing Address
First Line	:	18926 FORRER ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-2913
Country	:	US
Telephone Number	:	803-626-6504
Fax Number	:

Provider Business Practice Location Address
First Line	:	18926 FORRER ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-2913
Country	:	US
Telephone Number	:	803-626-6504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2018
Last Update Date	:	07/04/2018

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Directions to “ MIA HANCOCK ” Practice Location

Language	Start Address	Practice Location

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