Provider Demographics
NPI:1124803275
Name:LONG LIFE HOME HEALTH SERVICES LLC
Entity type:Organization
Organization Name:LONG LIFE HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAOTH
Authorized Official - Middle Name:SHAKER-SALAM
Authorized Official - Last Name:ABDELMALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-790-0700
Mailing Address - Street 1:28051 DEQUINDRE RD STE E
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28051 DEQUINDRE RD STE E
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3016
Practice Address - Country:US
Practice Address - Phone:248-443-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health