Provider Demographics
NPI:1699003467
Name:MIDWEST HOME CARE LLC
Entity Type:Organization
Organization Name:MIDWEST HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FADY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-906-2273
Mailing Address - Street 1:30777 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2549
Mailing Address - Country:US
Mailing Address - Phone:248-906-2273
Mailing Address - Fax:248-251-0249
Practice Address - Street 1:30777 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2549
Practice Address - Country:US
Practice Address - Phone:248-906-2273
Practice Address - Fax:248-251-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-05
Last Update Date:2009-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health