MEDICARE: LADEE WORLDWIDE 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1841074879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LADEE WORLDWIDE LLC

Provider Business Mailing Address
First Line	:	5362 MONROE ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2527
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5362 MONROE ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2527
Country	:	US
Telephone Number	:	313-653-9591
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	DEWANDA HICKS
Credential	:
Telephone Number	:	313-653-9591

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	08/21/2023

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