Provider Demographics
NPI:1225547920
Name:PRAYING HANDS HOME CARE LLC THANKS
Entity Type:Organization
Organization Name:PRAYING HANDS HOME CARE LLC THANKS
Other - Org Name:PRAYING HANDS HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNELL
Authorized Official - Middle Name:LATICHA
Authorized Official - Last Name:RAHEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-608-3150
Mailing Address - Street 1:4922 DIVISION AVE S STE 4
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-4496
Mailing Address - Country:US
Mailing Address - Phone:616-608-3150
Mailing Address - Fax:
Practice Address - Street 1:4922 DIVISION AVE S STE 4
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-4496
Practice Address - Country:US
Practice Address - Phone:616-608-3150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8265973Medicaid