Provider Demographics
NPI:1477313377
Name:LUDY, JERCENTIA M (HEALTH CARE PROVIDER)
Entity Type:Individual
Prefix:MS
First Name:JERCENTIA
Middle Name:M
Last Name:LUDY
Suffix:
Gender:F
Credentials:HEALTH CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20490 HARPER AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1645
Mailing Address - Country:US
Mailing Address - Phone:313-608-8253
Mailing Address - Fax:
Practice Address - Street 1:20490 HARPER AVE STE 108
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1645
Practice Address - Country:US
Practice Address - Phone:313-608-8253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care