MEDICARE: IMMANUEL HOME HELP CARE AGENCY 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	:	1811655137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMMANUEL HOME HELP CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	PO BOX 4
Second Line	:
City	:	WAYNE
State	:	MI
Zip	:	48184-0004
Country	:	US
Telephone Number	:	172-426-2199
Fax Number	:	313-397-2900

Provider Business Practice Location Address
First Line	:	13854 LAKESIDE CIR FL 2
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-1443
Country	:	US
Telephone Number	:	734-262-2199
Fax Number	:	313-397-2900

Authorized Official
Title or Position	:	ADMINISTRATOR/MANAGING EMPLOYER
Name	:	SHERON SALMAN
Credential	:	MPHA, BBA
Telephone Number	:	734-262-1997

Provider Enumeration Date	:	12/03/2021
Last Update Date	:	01/12/2024

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