Provider Demographics
NPI:1134305824
Name:SELECT COMFORT HOME HEALTHCARE SERVICE
Entity Type:Organization
Organization Name:SELECT COMFORT HOME HEALTHCARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:TENNETTE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:CENA
Authorized Official - Phone:248-547-5002
Mailing Address - Street 1:PO BOX 231141
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-9141
Mailing Address - Country:US
Mailing Address - Phone:248-547-5002
Mailing Address - Fax:
Practice Address - Street 1:22821 MANISTEE STREET
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2971
Practice Address - Country:US
Practice Address - Phone:248-547-5002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
MI2300010147770804376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty