Provider Demographics
NPI:1093585929
Name:ELENA HEARTS OF BLESS HANDS LLC
Entity Type:Organization
Organization Name:ELENA HEARTS OF BLESS HANDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSING ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MAREKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVEY-FORTSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:313-296-6155
Mailing Address - Street 1:3600 14TH ST APT 202
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2685
Mailing Address - Country:US
Mailing Address - Phone:313-296-6155
Mailing Address - Fax:
Practice Address - Street 1:3600 14TH ST APT 202
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2685
Practice Address - Country:US
Practice Address - Phone:313-296-6155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty