Provider Demographics
NPI:1679833081
Name:STAY AT HOME CARE
Entity Type:Organization
Organization Name:STAY AT HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:KEENE
Authorized Official - Last Name:RADEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-427-3286
Mailing Address - Street 1:PO BOX 771
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-0771
Mailing Address - Country:US
Mailing Address - Phone:313-427-3286
Mailing Address - Fax:313-381-2643
Practice Address - Street 1:15919 MOORE AVE
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1560
Practice Address - Country:US
Practice Address - Phone:313-427-3286
Practice Address - Fax:313-381-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care