Provider Demographics
NPI:1093282527
Name:CHARLI'S ANGELS HOME HEALTHCARE COMPANY
Entity Type:Organization
Organization Name:CHARLI'S ANGELS HOME HEALTHCARE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-525-0045
Mailing Address - Street 1:14570 PIEDMONT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2241
Mailing Address - Country:US
Mailing Address - Phone:313-525-0045
Mailing Address - Fax:
Practice Address - Street 1:14570 PIEDMONT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-2241
Practice Address - Country:US
Practice Address - Phone:313-525-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8763465Medicaid