Provider Demographics
NPI:1558332858
Name:MY PLACE HOME HEALTH CARE
Entity Type:Organization
Organization Name:MY PLACE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AFOLAKE
Authorized Official - Middle Name:ANTHONIA
Authorized Official - Last Name:BAMISHE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-557-0824
Mailing Address - Street 1:28860 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 261
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076
Mailing Address - Country:US
Mailing Address - Phone:248-557-0824
Mailing Address - Fax:248-557-0844
Practice Address - Street 1:28860 SOUTHFIELD RD
Practice Address - Street 2:SUITE 261
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076
Practice Address - Country:US
Practice Address - Phone:248-557-0824
Practice Address - Fax:248-557-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4709334251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4709334Medicaid
237535Medicare ID - Type Unspecified