Provider Demographics
NPI:1982062394
Name:IN-HOME HELP AGENCY LLC
Entity type:Organization
Organization Name:IN-HOME HELP AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KOKOETE
Authorized Official - Middle Name:
Authorized Official - Last Name:ETIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-416-8332
Mailing Address - Street 1:8904 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1821
Mailing Address - Country:US
Mailing Address - Phone:248-416-8332
Mailing Address - Fax:
Practice Address - Street 1:8904 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1821
Practice Address - Country:US
Practice Address - Phone:248-416-8332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
MI7908906253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7908906Medicaid