23D2029559 CLIA NUMBER - PROVIDERS HOME CARE LLC

Laboratory Demographics

  • CLIA Code: 23D2029559
  • Facility Name: PROVIDERS HOME CARE LLC
  • Facility Address: 14650 W WARREN, SUITE 250
    DEARBORN, MI
    ZIP 48126
  • Facility Phone: 313 274-8710
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: JAAFAR M. SHUKR
  • NPI Number: 1699283283
  • Taxonomy: 208100000X - Physical Medicine & Rehabilitation

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CLIA Record

Field Name Field Value
CLIA Number 23D2029559
LAB Type Home Health Agency
Facility Name PROVIDERS HOME CARE LLC
Street 14650 W WARREN, SUITE 250
City DEARBORN
State MI
ZIP 48126
Phone 313 274-8710
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/9/2025
Certificate Expiration Date 9/8/2027
Facility Type Home Health Agency
Lab Director JAAFAR M. SHUKR

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This page was last updated on: 9/29/2025