Provider Demographics
NPI:1487342374
Name:EYEWITNESS AT YOUR SERVICE LLC
Entity type:Organization
Organization Name:EYEWITNESS AT YOUR SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-477-5458
Mailing Address - Street 1:46300 LAKESIDE PARK DR APT 104
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5543
Mailing Address - Country:US
Mailing Address - Phone:313-753-0389
Mailing Address - Fax:586-317-6056
Practice Address - Street 1:46300 LAKESIDE PARK DR APT 104
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-5543
Practice Address - Country:US
Practice Address - Phone:313-753-0389
Practice Address - Fax:586-317-6056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No251E00000XAgenciesHome Health