Provider Demographics
NPI:1396178745
Name:BERTHA HOME HEALTH CARE
Entity Type:Organization
Organization Name:BERTHA HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ONEAL
Authorized Official - Last Name:TAIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-667-6730
Mailing Address - Street 1:17530 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2705
Mailing Address - Country:US
Mailing Address - Phone:248-667-6730
Mailing Address - Fax:
Practice Address - Street 1:17530 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2705
Practice Address - Country:US
Practice Address - Phone:248-667-6730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI05304X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health