Provider Demographics
NPI:1790972123
Name:PROVIDERS HOME CARE, LLC
Entity Type:Organization
Organization Name:PROVIDERS HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YAHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUKR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-274-8710
Mailing Address - Street 1:14650 W WARREN AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1700
Mailing Address - Country:US
Mailing Address - Phone:313-274-8710
Mailing Address - Fax:313-274-8711
Practice Address - Street 1:14650 W WARREN AVE STE 250
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1700
Practice Address - Country:US
Practice Address - Phone:313-274-8710
Practice Address - Fax:313-274-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health