Provider Demographics
NPI:1215536941
Name:EXTENDED HEARTS & HANDS HOME CARE
Entity Type:Organization
Organization Name:EXTENDED HEARTS & HANDS HOME CARE
Other - Org Name:EXTENDED HEARTS AND HANDS HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARQUISE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCQUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-727-4719
Mailing Address - Street 1:30800 NORTHWESTERN HWY STE 230
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2550
Mailing Address - Country:US
Mailing Address - Phone:124-857-1902
Mailing Address - Fax:
Practice Address - Street 1:30800 NORTHWESTERN HWY STE 230
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2550
Practice Address - Country:US
Practice Address - Phone:124-857-1902
Practice Address - Fax:248-829-7232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No251K00000XAgenciesPublic Health or Welfare
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9390788Medicaid