Provider Demographics
NPI:1437398914
Name:PRUDENTIAL HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:PRUDENTIAL HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANDNI
Authorized Official - Middle Name:
Authorized Official - Last Name:EJAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-252-6726
Mailing Address - Street 1:26789 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1335
Mailing Address - Country:US
Mailing Address - Phone:248-252-6726
Mailing Address - Fax:
Practice Address - Street 1:26789 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1335
Practice Address - Country:US
Practice Address - Phone:248-252-6726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health