Provider Demographics
NPI:1417579376
Name:AH TROY SUBTENANT, LLC
Entity Type:Organization
Organization Name:AH TROY SUBTENANT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-589-3555
Mailing Address - Street 1:2300 GRAND HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4418
Mailing Address - Country:US
Mailing Address - Phone:248-589-3555
Mailing Address - Fax:248-589-9949
Practice Address - Street 1:2300 GRAND HAVEN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4418
Practice Address - Country:US
Practice Address - Phone:248-589-3555
Practice Address - Fax:248-589-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332U00000XSuppliersHome Delivered MealsGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty