Provider Demographics
NPI:1962254920
Name:MEADOW OAKS HOME CARE LLC
Entity type:Organization
Organization Name:MEADOW OAKS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RN
Authorized Official - Prefix:
Authorized Official - First Name:AKILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:313-626-0220
Mailing Address - Street 1:21601 CLOVERLAWN ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2630
Mailing Address - Country:US
Mailing Address - Phone:313-605-6080
Mailing Address - Fax:
Practice Address - Street 1:21601 CLOVERLAWN ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2630
Practice Address - Country:US
Practice Address - Phone:131-360-5608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No253Z00000XAgenciesIn Home Supportive Care