Organization
BLUE LEAF HOMECARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TATISHA MILLER (OWNER/ CHIEF OPERATING OFFICER)
(313) 405-7668
Entity
Organization
Contact information
Practice address
18701 GRAND RIVER AVE # 327, DETROIT, MI 48223-2214
(313) 405-7668
(313) 450-4321
Mailing address
29488 WOODWARD AVE, #234, ROYAL OAK, MI 48073-0903
(313) 405-7668
(313) 450-4321
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
03/16/2011
Last updated
09/07/2012
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