MEDICARE: AMERICAN HOMECARE HOSPICE 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	251G00000X	Community Based Hospice Care Agency		MI

General Provider Information

NPI Number	:	1801189204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN HOMECARE HOSPICE LLC

Provider Business Mailing Address
First Line	:	4245 S BEECH DALY ST
Second Line	:	SUITE 201
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-1567
Country	:	US
Telephone Number	:	734-846-4483
Fax Number	:	313-277-5502

Provider Business Practice Location Address
First Line	:	4245 S BEECH DALY ST
Second Line	:	SUITE 201
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-1567
Country	:	US
Telephone Number	:	734-846-4483
Fax Number	:	313-277-5502

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	NAFIS A MIRZA
Credential	:
Telephone Number	:	734-846-4483

Provider Enumeration Date	:	05/18/2011
Last Update Date	:	05/18/2011

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