Provider Demographics
NPI:1154175214
Name:PROFESSIONALIZED HOME CARE LLC
Entity type:Organization
Organization Name:PROFESSIONALIZED HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:N
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-457-4114
Mailing Address - Street 1:24123 GREENFIELD RD STE 311
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3124
Mailing Address - Country:US
Mailing Address - Phone:313-457-4114
Mailing Address - Fax:
Practice Address - Street 1:24123 GREENFIELD RD STE 311
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3124
Practice Address - Country:US
Practice Address - Phone:313-457-4114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care