Provider Demographics
NPI:1104791979
Name:VON HOMECARE AGENCY
Entity type:Organization
Organization Name:VON HOMECARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:HOME HEALTH CARE
Authorized Official - Phone:586-222-5988
Mailing Address - Street 1:4909 MORAN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-1278
Mailing Address - Country:US
Mailing Address - Phone:586-222-5988
Mailing Address - Fax:
Practice Address - Street 1:4909 MORAN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-1278
Practice Address - Country:US
Practice Address - Phone:586-222-5988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health