Provider Demographics
NPI:1790075240
Name:EXPRESS HOME DELIVERIES,LLC
Entity Type:Organization
Organization Name:EXPRESS HOME DELIVERIES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:LARAINE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-953-4388
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-0217
Mailing Address - Country:US
Mailing Address - Phone:313-953-4388
Mailing Address - Fax:313-908-2435
Practice Address - Street 1:25962 NORFOLK ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2432
Practice Address - Country:US
Practice Address - Phone:313-953-4388
Practice Address - Fax:313-908-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI253Z00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle