Provider Demographics
NPI:1538956461
Name:WAYNE COUNTY HOME CARE LLC
Entity type:Organization
Organization Name:WAYNE COUNTY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:124-850-8200
Mailing Address - Street 1:1707 SHORE CLUB DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1567
Mailing Address - Country:US
Mailing Address - Phone:248-508-2004
Mailing Address - Fax:800-925-7765
Practice Address - Street 1:1707 SHORE CLUB DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1567
Practice Address - Country:US
Practice Address - Phone:248-508-2004
Practice Address - Fax:800-925-7765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty