Provider Demographics
NPI:1629895487
Name:SENIOR INDEPENDENCE HOME CARE LLC
Entity type:Organization
Organization Name:SENIOR INDEPENDENCE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RASHAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAZZY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-460-8884
Mailing Address - Street 1:23645 CHERRY HILL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1415
Mailing Address - Country:US
Mailing Address - Phone:313-460-8884
Mailing Address - Fax:
Practice Address - Street 1:23645 CHERRY HILL ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1415
Practice Address - Country:US
Practice Address - Phone:313-460-8884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care