Provider Demographics
NPI:1245745447
Name:SUPPORTIVE HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:SUPPORTIVE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MALECKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-291-5806
Mailing Address - Street 1:32003 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1927
Mailing Address - Country:US
Mailing Address - Phone:248-291-5806
Mailing Address - Fax:248-281-1016
Practice Address - Street 1:32003 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1927
Practice Address - Country:US
Practice Address - Phone:248-291-5806
Practice Address - Fax:248-281-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WH0200X, 163WI0500X, 2251G0304X, 225700000X, 225X00000X
MI237746251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty