# HOME VISITING PROVIDERS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013515931
- **Authorized official:** DIANE JAWAD (BILLER)
- **Authorized official phone:** (313) 415-1515

## Contact information

- **Practice address:** 7542 WYOMING ST, DEARBORN, MI 48126-1690
- **Practice address phone:** (313) 415-1515
- **Mailing address:** 7542 WYOMING ST, DEARBORN, MI 48126-1690
- **Mailing address phone:** (313) 415-1515

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 10/13/2020
- **Last updated:** 07/01/2021