Provider Demographics
NPI:1295428258
Name:DOMINION STAFFING LLC
Entity type:Organization
Organization Name:DOMINION STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FESTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-888-5097
Mailing Address - Street 1:24655 SOUTHFIELD RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-8100
Mailing Address - Country:US
Mailing Address - Phone:313-888-5097
Mailing Address - Fax:
Practice Address - Street 1:24655 SOUTHFIELD RD STE 104
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-8100
Practice Address - Country:US
Practice Address - Phone:313-888-5097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care