Provider Demographics
NPI:1083131122
Name:ST AGATHA HOME CARE LLC
Entity Type:Organization
Organization Name:ST AGATHA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEVLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-703-6201
Mailing Address - Street 1:30850 TELEGRAPH RD STE 250
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4579
Mailing Address - Country:US
Mailing Address - Phone:248-703-6201
Mailing Address - Fax:248-987-0490
Practice Address - Street 1:16715 SAVOIE ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3321
Practice Address - Country:US
Practice Address - Phone:734-261-2248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care