1881072221 NPI number — PROVIDING HEARTS HOME HEALTH SERVICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881072221 NPI number — PROVIDING HEARTS HOME HEALTH SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROVIDING HEARTS HOME HEALTH SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881072221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 TOWN CENTER
Provider Second Line Business Mailing Address:
STE 1900
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48075-1152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-790-0039
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 TOWN CTR
Provider Second Line Business Practice Location Address:
SUITE 1900
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075-1135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-790-0039
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JAMES
Authorized Official First Name:
JAMAL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MEMBER/MANAGER
Authorized Official Telephone Number:
248-790-0039

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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