Provider Demographics
NPI:1497057632
Name:CLASSIC HOME HEALTH SERVICES INC
Entity Type:Organization
Organization Name:CLASSIC HOME HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TARIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-633-0765
Mailing Address - Street 1:4245 BEECH DALY
Mailing Address - Street 2:SUITE B
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-1576
Mailing Address - Country:US
Mailing Address - Phone:313-633-0765
Mailing Address - Fax:313-633-0938
Practice Address - Street 1:4245 BEECH DALY
Practice Address - Street 2:SUITE B
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-1576
Practice Address - Country:US
Practice Address - Phone:313-633-0765
Practice Address - Fax:313-633-0938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-9224Medicare PIN