Provider Demographics
NPI:1386298438
Name:JEWELS HOME HEALTH CARE SERVICE, LLC
Entity type:Organization
Organization Name:JEWELS HOME HEALTH CARE SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREISDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDIFER
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:248-802-1605
Mailing Address - Street 1:14005 ROSELAWN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-2469
Mailing Address - Country:US
Mailing Address - Phone:284-802-1605
Mailing Address - Fax:313-646-9791
Practice Address - Street 1:14005 ROSELAWN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-2469
Practice Address - Country:US
Practice Address - Phone:284-802-1605
Practice Address - Fax:313-646-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-27
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care