Provider Demographics
NPI:1689188765
Name:HILL & DESIRE HEALTHCARE PLLC
Entity Type:Organization
Organization Name:HILL & DESIRE HEALTHCARE PLLC
Other - Org Name:I AM HEALTH AND WELLNESS OF BELLEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEODGE
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:313-475-8896
Mailing Address - Street 1:25 OWEN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2921
Mailing Address - Country:US
Mailing Address - Phone:734-699-5400
Mailing Address - Fax:734-699-5455
Practice Address - Street 1:25 OWEN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2921
Practice Address - Country:US
Practice Address - Phone:734-699-5400
Practice Address - Fax:734-699-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004307363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty