Provider Demographics
NPI:1952177156
Name:PURPLE WINGS HOME CARE, LLC
Entity Type:Organization
Organization Name:PURPLE WINGS HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-728-7749
Mailing Address - Street 1:16840 WOODBINE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3742
Mailing Address - Country:US
Mailing Address - Phone:313-728-7749
Mailing Address - Fax:
Practice Address - Street 1:16840 WOODBINE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3742
Practice Address - Country:US
Practice Address - Phone:313-728-7749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PURPLE WINGS HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty