Provider Demographics
NPI:1619599768
Name:EVANGELICAL HOME CARE,LLC
Entity Type:Organization
Organization Name:EVANGELICAL HOME CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:GENEROSA
Authorized Official - Middle Name:F
Authorized Official - Last Name:AGUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-302-5194
Mailing Address - Street 1:23800 W 10 MILE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3194
Mailing Address - Country:US
Mailing Address - Phone:248-302-5194
Mailing Address - Fax:248-559-9663
Practice Address - Street 1:23800 W 10 MILE RD STE 108
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-3194
Practice Address - Country:US
Practice Address - Phone:248-302-5194
Practice Address - Fax:248-559-9663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health