Provider Demographics
NPI:1801062690
Name:CHARTER HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:CHARTER HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAID
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-556-5734
Mailing Address - Street 1:26711 WOODWARD AVE
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1333
Mailing Address - Country:US
Mailing Address - Phone:248-556-5734
Mailing Address - Fax:248-556-5831
Practice Address - Street 1:26711 WOODWARD AVE
Practice Address - Street 2:SUITE # 201
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1333
Practice Address - Country:US
Practice Address - Phone:248-556-5734
Practice Address - Fax:248-556-5831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI239030Medicare Oscar/Certification