Provider Demographics
NPI:1952678492
Name:PURPOSE HOME CARE
Entity Type:Organization
Organization Name:PURPOSE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRIUS
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-718-3775
Mailing Address - Street 1:14123 GLENWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5424
Mailing Address - Country:US
Mailing Address - Phone:586-718-3775
Mailing Address - Fax:586-722-0635
Practice Address - Street 1:14123 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-5424
Practice Address - Country:US
Practice Address - Phone:586-718-3775
Practice Address - Fax:586-722-0635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0064080251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0064080Medicaid