Provider Demographics
NPI:1831249432
Name:KELLY HOME CARE SERVICES, INC.
Entity type:Organization
Organization Name:KELLY HOME CARE SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS UNIT LEADER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE (SHELLE)
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-244-4917
Mailing Address - Street 1:999 W BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4716
Mailing Address - Country:US
Mailing Address - Phone:248-362-4444
Mailing Address - Fax:248-244-5247
Practice Address - Street 1:999 W BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4716
Practice Address - Country:US
Practice Address - Phone:248-362-4444
Practice Address - Fax:248-244-5247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0055251E00000X
NCHC0246251E00000X
NCHC0054251E00000X
NCHC0056251E00000X
VAHCO-07312251E00000X
VAHCO-07291251E00000X
VAHCO-07145251E00000X
VAHCO-07142251E00000X
WAIS-355251E00000X
GA044-R-0003251E00000X
GA121-R-0022251E00000X
GA025-R-0009251E00000X
TX003064251E00000X
OR15-2036251E00000X
FL20609096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0031086000Medicaid
WA397122OtherALTCEW BR.6282 SPOKANE
OR112182OtherKAISER PERMANENTE
CA009213OtherSCAN BR.1481 PASADENA
VA3133OtherCITY OF VA BEACH-LOCAL CO
CA013531OtherSCAN BR.1585 ORANGE CO.
CA015027OtherSCAN BR.1497 CULVER
PA11489OtherCUMBERLAND CO, BR.5180
NC3408499Medicaid