- Enrollment id
- O20230825000237
- Enrollment state
- MI
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1831885029
- Multiple npi flag
- N
- Ccn
- 239353
- Associate id
- 2062875982
- Organization name
- PROACTIVE HOME HEALTH CARE SERVICES LLC
- Incorporation date
- 2023-02-07
- Incorporation state
- MI
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 52188 VAN DYKE AVE
- Address line 2
- STE 201A-2
- City
- SHELBY TOWNSHIP
- State
- MI
- Zip code
- 483163567