Provider Demographics
NPI:1700573623
Name:TAKE CARE HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:TAKE CARE HOME HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-782-3330
Mailing Address - Street 1:8326 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2759
Mailing Address - Country:US
Mailing Address - Phone:347-782-3330
Mailing Address - Fax:
Practice Address - Street 1:8326 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2759
Practice Address - Country:US
Practice Address - Phone:347-782-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-20
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9572932Medicaid