Provider Demographics
NPI:1962455121
Name:ELSMAR HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:ELSMAR HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:313-961-5500
Mailing Address - Street 1:2727 2ND AVE
Mailing Address - Street 2:SUITE 156
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2658
Mailing Address - Country:US
Mailing Address - Phone:313-961-5500
Mailing Address - Fax:313-961-5501
Practice Address - Street 1:2727 2ND AVE
Practice Address - Street 2:SUITE 156
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2658
Practice Address - Country:US
Practice Address - Phone:313-961-5500
Practice Address - Fax:313-961-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5189954Medicaid
MI237665Medicare Oscar/Certification