Provider Demographics
NPI:1053392167
Name:MY HOME MD, PLCC
Entity type:Organization
Organization Name:MY HOME MD, PLCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:HAITHCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-558-9545
Mailing Address - Street 1:28855 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2744
Mailing Address - Country:US
Mailing Address - Phone:586-558-9545
Mailing Address - Fax:586-558-9541
Practice Address - Street 1:28855 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2744
Practice Address - Country:US
Practice Address - Phone:586-558-9545
Practice Address - Fax:586-558-9541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health