Provider Demographics
NPI:1912317678
Name:SUREAL LOVING HOME CARE
Entity Type:Organization
Organization Name:SUREAL LOVING HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LADANNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BIBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-559-6311
Mailing Address - Street 1:11387 RIVARD AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-3025
Mailing Address - Country:US
Mailing Address - Phone:313-559-6311
Mailing Address - Fax:
Practice Address - Street 1:11387 RIVARD AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-3025
Practice Address - Country:US
Practice Address - Phone:313-559-6311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUREAL LOVING HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-04
Last Update Date:2014-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health