Provider Demographics
NPI:1396294559
Name:SAMARITAN HOME HELP LLC
Entity type:Organization
Organization Name:SAMARITAN HOME HELP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-739-4519
Mailing Address - Street 1:18301 E 8 MILE RD STE 213
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3227
Mailing Address - Country:US
Mailing Address - Phone:313-739-4519
Mailing Address - Fax:
Practice Address - Street 1:18301 E 8 MILE RD STE 213
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3227
Practice Address - Country:US
Practice Address - Phone:313-739-4519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMARITAN HOME HELP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8002855Medicaid