Organization
MOMBA HOME CARE MICHIGAN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELAZAR HUISMAN (NPI MANAGER)
(404) 418-7484
Entity
Organization
Contact information
Practice address
3200 GREENFIELD RD STE 300, DEARBORN, MI 48120-1805
(248) 290-9621
Mailing address
400 PERIMETER CENTER TER NE STE 300, ATLANTA, GA 30346-1201
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265260566
MI CHOICE WAIVER
MI
Enumeration date
12/05/2024
Last updated
04/21/2026
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