Provider Demographics
NPI:1609297753
Name:PRIDE HOME HEALTH
Entity Type:Organization
Organization Name:PRIDE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MUZAFAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-890-6058
Mailing Address - Street 1:2101 CRYSTAL LAKE DR APT Q-311
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-4723
Mailing Address - Country:US
Mailing Address - Phone:248-890-6058
Mailing Address - Fax:586-991-5605
Practice Address - Street 1:2101 CRYSTAL LAKE DR APT Q-311
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-4723
Practice Address - Country:US
Practice Address - Phone:248-890-6058
Practice Address - Fax:586-991-5605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIDE HOME HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-16
Last Update Date:2013-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005207251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health