Provider Demographics
NPI:1376019901
Name:HEALING PLACE HOME CARE LLC @GMAIL.COM
Entity Type:Organization
Organization Name:HEALING PLACE HOME CARE LLC @GMAIL.COM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKERRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-604-5023
Mailing Address - Street 1:26601 CLANCY ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-3150
Mailing Address - Country:US
Mailing Address - Phone:586-604-5023
Mailing Address - Fax:
Practice Address - Street 1:26601 CLANCY ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-3150
Practice Address - Country:US
Practice Address - Phone:586-604-5023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health