Provider Demographics
NPI:1336588524
Name:LOVING MEMORIES HEALTH CARE LLC
Entity Type:Organization
Organization Name:LOVING MEMORIES HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GENEVA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:248-924-2647
Mailing Address - Street 1:2280 LA BELLE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-2944
Mailing Address - Country:US
Mailing Address - Phone:248-747-4074
Mailing Address - Fax:248-747-4074
Practice Address - Street 1:2280 LA BELLE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-2944
Practice Address - Country:US
Practice Address - Phone:248-747-4074
Practice Address - Fax:248-747-4074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care