Provider Demographics
NPI:1710222914
Name:HOMEAIDELLC
Entity Type:Organization
Organization Name:HOMEAIDELLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:N
Authorized Official - Last Name:THIBAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-744-5496
Mailing Address - Street 1:15105 YALE ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-7108
Mailing Address - Country:US
Mailing Address - Phone:734-744-5496
Mailing Address - Fax:
Practice Address - Street 1:15105 YALE ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-7108
Practice Address - Country:US
Practice Address - Phone:734-744-5496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health