Provider Demographics
NPI:1740777291
Name:SHANNY'S HOME CARE LLC
Entity Type:Organization
Organization Name:SHANNY'S HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARECIA
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-443-3334
Mailing Address - Street 1:19194 PACKARD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-3106
Mailing Address - Country:US
Mailing Address - Phone:586-443-3334
Mailing Address - Fax:866-243-4640
Practice Address - Street 1:19194 PACKARD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3106
Practice Address - Country:US
Practice Address - Phone:586-443-3334
Practice Address - Fax:866-243-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1194001727OtherHOME CARE