MEDICARE: PUREHAVEN HOMECARE 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	:	1942155114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUREHAVEN HOMECARE LLC

Provider Business Mailing Address
First Line	:	4139 WILLIAMS ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2751
Country	:	US
Telephone Number	:	734-262-5082
Fax Number	:

Provider Business Practice Location Address
First Line	:	4139 WILLIAMS ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2751
Country	:	US
Telephone Number	:	734-262-5082
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JODIANN JAMES
Credential	:	RN
Telephone Number	:	313-285-4897

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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