Provider Demographics
NPI:1760771430
Name:MISSION HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:MISSION HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:B
Authorized Official - Last Name:SULLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-968-4341
Mailing Address - Street 1:5820 N LILLEY RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3686
Mailing Address - Country:US
Mailing Address - Phone:734-335-6393
Mailing Address - Fax:734-335-6774
Practice Address - Street 1:5820 N LILLEY RD
Practice Address - Street 2:SUITE 5
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3686
Practice Address - Country:US
Practice Address - Phone:734-335-6393
Practice Address - Fax:734-335-6774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI239247Medicare Oscar/Certification