Provider Demographics
NPI:1831515089
Name:MAVIS HOME CARE LLC
Entity type:Organization
Organization Name:MAVIS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:WARDFORD
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-454-3150
Mailing Address - Street 1:8325 E JEFFERSON AVE # 104
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-2797
Mailing Address - Country:US
Mailing Address - Phone:313-454-3150
Mailing Address - Fax:313-454-3150
Practice Address - Street 1:8325 E JEFFERSON AVE # 104
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2797
Practice Address - Country:US
Practice Address - Phone:313-454-3150
Practice Address - Fax:313-454-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI144596253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care