Provider Demographics
NPI:1679739122
Name:HOME MDS L.L.C
Entity type:Organization
Organization Name:HOME MDS L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FANNY
Authorized Official - Middle Name:AGUIRRE
Authorized Official - Last Name:DELA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-744-8560
Mailing Address - Street 1:17880 FARMINGTON RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3104
Mailing Address - Country:US
Mailing Address - Phone:734-744-8560
Mailing Address - Fax:734-744-8563
Practice Address - Street 1:17880 FARMINGTON RD
Practice Address - Street 2:UNIT B
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3104
Practice Address - Country:US
Practice Address - Phone:734-744-8560
Practice Address - Fax:734-744-8563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI36977208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty