Provider Demographics
NPI:1598936601
Name:TOTAL LIVING HOME HEALTH CARE SERVICE, INC.
Entity Type:Organization
Organization Name:TOTAL LIVING HOME HEALTH CARE SERVICE, INC.
Other - Org Name:TOTAL LIVING HOME HEALTH CARE INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-557-1965
Mailing Address - Street 1:17697 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2727
Mailing Address - Country:US
Mailing Address - Phone:248-557-1965
Mailing Address - Fax:248-557-2448
Practice Address - Street 1:17697 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2727
Practice Address - Country:US
Practice Address - Phone:248-557-1965
Practice Address - Fax:248-557-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5360090Medicaid