MEDICARE: GREEN HEART HOME 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	:	1841149440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN HEART HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	19301 HOUGHTON ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-1825
Country	:	US
Telephone Number	:	248-234-1544
Fax Number	:

Provider Business Practice Location Address
First Line	:	19301 HOUGHTON ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-1825
Country	:	US
Telephone Number	:	248-234-1544
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	MARY HOLT
Credential	:
Telephone Number	:	248-234-1544

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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