MEDICARE: STEPHAINE MANN CNA

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	MIGA03142025293466	MI

General Provider Information

NPI Number	:	1952298143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHAINE MANN CNA

Provider Business Mailing Address
First Line	:	21366 HALL RD UNIT 4037
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1539
Country	:	US
Telephone Number	:	313-590-7785
Fax Number	:

Provider Business Practice Location Address
First Line	:	21366 HALL RD UNIT 4037
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1539
Country	:	US
Telephone Number	:	313-590-7785
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2025
Last Update Date	:	06/20/2025

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Directions to “ STEPHAINE MANN CNA” Practice Location

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