Provider Demographics
NPI:1902124530
Name:FAIRLANE HOME HEALTH CARE AGENCY INC
Entity Type:Organization
Organization Name:FAIRLANE HOME HEALTH CARE AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TALAL
Authorized Official - Middle Name:H
Authorized Official - Last Name:SABRAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-588-2403
Mailing Address - Street 1:14847 GRATIOT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-1942
Mailing Address - Country:US
Mailing Address - Phone:313-588-2403
Mailing Address - Fax:
Practice Address - Street 1:14847 GRATIOT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1942
Practice Address - Country:US
Practice Address - Phone:313-588-2403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health