Provider Demographics
NPI:1164822128
Name:ABBOTT HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:ABBOTT HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:OHAKPO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MSN
Authorized Official - Phone:313-535-4833
Mailing Address - Street 1:18230 W MCNICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-4163
Mailing Address - Country:US
Mailing Address - Phone:313-535-4833
Mailing Address - Fax:313-535-5393
Practice Address - Street 1:18230 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-4163
Practice Address - Country:US
Practice Address - Phone:313-535-4833
Practice Address - Fax:313-535-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704187806253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care