MEDICARE: MAVIS HOME CARE 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	144596	MI

General Provider Information

NPI Number	:	1831515089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAVIS HOME CARE LLC

Provider Business Mailing Address
First Line	:	8325 E JEFFERSON AVE # 104
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-2797
Country	:	US
Telephone Number	:	313-454-3150
Fax Number	:	313-454-3150

Provider Business Practice Location Address
First Line	:	8325 E JEFFERSON AVE # 104
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-2797
Country	:	US
Telephone Number	:	313-454-3150
Fax Number	:	313-454-3150

Authorized Official
Title or Position	:	MEMBER
Name	:	MRS. VICKY WARDFORD POLK
Credential	:
Telephone Number	:	313-454-3150

Provider Enumeration Date	:	03/12/2014
Last Update Date	:	03/12/2014

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Directions to “MAVIS HOME CARE LLC ” Practice Location

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