Provider Demographics
NPI:1760056279
Name:GRANNY'S HELPERS
Entity type:Organization
Organization Name:GRANNY'S HELPERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAKESHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:CAREGIVER
Authorized Official - Phone:313-723-7461
Mailing Address - Street 1:11000 W MCNICHOLS RD SUTE323 #1366
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2393
Mailing Address - Country:US
Mailing Address - Phone:313-723-7461
Mailing Address - Fax:313-836-1883
Practice Address - Street 1:19301 ARDMORE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1704
Practice Address - Country:US
Practice Address - Phone:313-340-2646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1760056279Medicaid
MI118128767OtherDUN
MI1598446007Medicaid
MI1669046173Medicaid
FMED1SRNSUN271OtherED1