Provider Demographics
NPI:1821412057
Name:BURNETT HOME CARE LLC
Entity Type:Organization
Organization Name:BURNETT HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALENCIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-728-4365
Mailing Address - Street 1:18282 SHAFTSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2850
Mailing Address - Country:US
Mailing Address - Phone:313-728-4365
Mailing Address - Fax:
Practice Address - Street 1:18282 SHAFTSBURY AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-2850
Practice Address - Country:US
Practice Address - Phone:313-728-4365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health