Provider Demographics
NPI:1801178447
Name:MICHIGAN HOME ASSIST
Entity Type:Organization
Organization Name:MICHIGAN HOME ASSIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAKEISHA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-394-7846
Mailing Address - Street 1:4130 COMSTOCK AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-3761
Mailing Address - Country:US
Mailing Address - Phone:810-394-7846
Mailing Address - Fax:
Practice Address - Street 1:509 W COURT ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5020
Practice Address - Country:US
Practice Address - Phone:810-394-7846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI253Z00000253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care