Organization
RANDYS PLACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ENDIA HAWKINS BSN, RN (OWNER)
(313) 479-6199
Entity
Organization
Contact information
Practice address
5910 LAKEWOOD ST, DETROIT, MI 48213-3639
(313) 479-6199
(313) 391-5799
Mailing address
5816 NEWPORT ST, DETROIT, MI 48213-3641
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
310500000X
Mental Illness Intermediate Care Facility
—
—
311Z00000X
Custodial Care Facility
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
04/17/2025
Last updated
05/12/2025
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