MEDICARE: LOVING HANDS ADULT DAY CARE&THERAPEUTIC CLINIC 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	1041C0700X	Clinical Social Worker
2	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1992128110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING HANDS ADULT DAY CARE&THERAPEUTIC CLINIC LLC

Provider Business Mailing Address
First Line	:	1056 S PATRICIA ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48217-1230
Country	:	US
Telephone Number	:	313-544-0731
Fax Number	:	313-849-2763

Provider Business Practice Location Address
First Line	:	1056 S PATRICIA ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48217-1230
Country	:	US
Telephone Number	:	313-544-0731
Fax Number	:	313-849-2763

Authorized Official
Title or Position	:	CEO
Name	:	MR. TERENCE DALE WOOLFORK
Credential	:
Telephone Number	:	313-544-0731

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	01/23/2014

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