Provider Demographics
NPI:1770208092
Name:MOTHER'S HEART LLC
Entity type:Organization
Organization Name:MOTHER'S HEART LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:872-333-6437
Mailing Address - Street 1:PO BOX 2658
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48123-2658
Mailing Address - Country:US
Mailing Address - Phone:872-216-7015
Mailing Address - Fax:
Practice Address - Street 1:23169 MICHIGAN AVE # 2658
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-0001
Practice Address - Country:US
Practice Address - Phone:872-216-7015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care