Provider Demographics
NPI:1992127104
Name:FAMILY EMBRACE HOME HEALTH AGENCY
Entity type:Organization
Organization Name:FAMILY EMBRACE HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIQUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-371-0561
Mailing Address - Street 1:24725 W 12 MILE RD
Mailing Address - Street 2:STE 120
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1801
Mailing Address - Country:US
Mailing Address - Phone:770-371-0561
Mailing Address - Fax:
Practice Address - Street 1:24725 W 12 MILE RD
Practice Address - Street 2:STE 120
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1801
Practice Address - Country:US
Practice Address - Phone:770-371-0561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704218369251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1073934329OtherNPI INDIVIDUAL