Provider Demographics
NPI:1699018788
Name:LATIVAH'S HOME HEALTH CARE SERVICE L.L.C
Entity Type:Organization
Organization Name:LATIVAH'S HOME HEALTH CARE SERVICE L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATIVAH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-455-8629
Mailing Address - Street 1:15200 E JEFFERSON AVE
Mailing Address - Street 2:SUITE 108A
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1304
Mailing Address - Country:US
Mailing Address - Phone:313-455-8629
Mailing Address - Fax:
Practice Address - Street 1:15200 E JEFFERSON AVE
Practice Address - Street 2:SUITE 108A
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1304
Practice Address - Country:US
Practice Address - Phone:313-455-8629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health