Provider Demographics
NPI:1154591824
Name:FAIRLANE HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:FAIRLANE HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FAKEHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-306-1992
Mailing Address - Street 1:4 PARKLANE BLVD STE 360
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2660
Mailing Address - Country:US
Mailing Address - Phone:313-982-3000
Mailing Address - Fax:313-982-3003
Practice Address - Street 1:4 PARKLANE BLVD STE 360
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2660
Practice Address - Country:US
Practice Address - Phone:313-982-3000
Practice Address - Fax:313-982-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-09
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health