Provider Demographics
NPI:1215595061
Name:MADAME PAULETTES REGAL SERVICES
Entity Type:Organization
Organization Name:MADAME PAULETTES REGAL SERVICES
Other - Org Name:MADAME PAULETTE'S REGAL SERVICES LLC HOME HEALTH CARE PROVIDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-854-8655
Mailing Address - Street 1:12630 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1502
Mailing Address - Country:US
Mailing Address - Phone:313-854-8655
Mailing Address - Fax:
Practice Address - Street 1:12630 KELLY RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1502
Practice Address - Country:US
Practice Address - Phone:313-854-8655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADAME PAULETTE'S REGAL SERVICES LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-05
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No347C00000XTransportation ServicesPrivate VehicleGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8824730Medicaid