MEDICARE: MOTHERS AND INFANT SUPPORT

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

General Provider Information

NPI Number	:	1871999185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTHERS AND INFANT SUPPORT

Provider Business Mailing Address
First Line	:	36843 KYRO CT
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4600
Country	:	US
Telephone Number	:	586-601-6434
Fax Number	:

Provider Business Practice Location Address
First Line	:	36843 KYRO CT
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4600
Country	:	US
Telephone Number	:	586-601-6434
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ATHRAA HADDAD
Credential	:	ASW
Telephone Number	:	586-601-6434

Provider Enumeration Date	:	11/13/2014
Last Update Date	:	11/13/2014

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Directions to “MOTHERS AND INFANT SUPPORT ” Practice Location

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