Provider Demographics
NPI:1386692945
Name:EXECUTIVE HOME HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:EXECUTIVE HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:MOFOZZOL
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-967-9998
Mailing Address - Street 1:25900 GREENFIELD RD
Mailing Address - Street 2:SUITE - 410
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1292
Mailing Address - Country:US
Mailing Address - Phone:248-967-9998
Mailing Address - Fax:248-460-4200
Practice Address - Street 1:25900 GREENFIELD RD
Practice Address - Street 2:SUITE - 410
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1292
Practice Address - Country:US
Practice Address - Phone:248-967-9998
Practice Address - Fax:248-460-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI237660251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237660Medicare ID - Type UnspecifiedHOME HEALTH SERVICES