Provider Demographics
NPI:1023998630
Name:ASSISTED LIVING SUPPORT SERVICE LLC
Entity type:Organization
Organization Name:ASSISTED LIVING SUPPORT SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:HODON
Authorized Official - Middle Name:O
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-883-3370
Mailing Address - Street 1:5898 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-0030
Mailing Address - Country:US
Mailing Address - Phone:734-883-3370
Mailing Address - Fax:
Practice Address - Street 1:5898 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-0030
Practice Address - Country:US
Practice Address - Phone:734-883-3370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care