Provider Demographics
NPI:1861624967
Name:SIERRA PRIDE HOME HEALTHCARE AGENCY LLC
Entity type:Organization
Organization Name:SIERRA PRIDE HOME HEALTHCARE AGENCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO AND ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMED
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:248-321-7206
Mailing Address - Street 1:29333 TRAILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4696
Mailing Address - Country:US
Mailing Address - Phone:248-321-7206
Mailing Address - Fax:585-619-9312
Practice Address - Street 1:29333 TRAILWOOD DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4696
Practice Address - Country:US
Practice Address - Phone:248-321-7206
Practice Address - Fax:585-619-9312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-22
Last Update Date:2009-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health