Tuckerville.LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

E79564 Issued in MI

Legal business name

TUCKERVILLE.LLC

Practice address

35230 E Michigan Ave
Wayne, MI 48184-3698

Phone

(313) 312-5706

NPI assigned

Feb 2, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Fartima Tucker, LMSW, IMH-E(II)NPI 1396097457

Title

Ceo/Owner

Phone

(313) 303-7423

Specialties & licenses 6

Addresses

Other identifiers 3

Tax ID family

Tuckerville2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Tuckerville

  • Clinical Social Worker
  • Wayne, MI
  • NPI 1437626454
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fartima Tucker, L.M.S.W

  • Clinical Social Worker
  • Wayne, MI
  • NPI 1396097457
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679616000000",
    "number": "1063870293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 125",
            "city": "BELLEVILLE",
            "state": "MI",
            "postal_code": "481120125",
            "telephone_number": "313-303-7423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35230 E MICHIGAN AVE",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "481843698",
            "telephone_number": "313-312-5706"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9257 E Walden Dr",
            "address_purpose": "LOCATION",
            "city": "Belleville",
            "state": "MI",
            "postal_code": "481112488",
            "country_code": "US",
            "telephone_number": "313-303-7423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TUCKERVILLE.LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-02",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-24",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "FARTIMA",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "313-303-7423",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMSW, IMH-E(II)"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MI",
            "license": "E79564",
            "primary": true
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "MI",
            "license": "E79564",
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "MI",
            "license": "E79564",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "MI",
            "license": "E79564",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8025368",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUCKERVILLE, LLC",
            "identifier": "1437626454",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1396097457",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ana-Maria Tsourapas, PA
• Fartima Tucker, L.M.S.W
• Tuckerville
• Tuckerville Transitions
• Tuckerville Transitions Org
• Catherine Turner, RN
• Veronica Tyree
• U.S. Rehabilitation and Health Service, Inc
• Jawad Ul-Hassan, D.O
• Zachary Sanjeev Vaishampayan, MD

• Home Health Agency in Wayne, MI
• Providers in Wayne, MI by specialty
• Home Health Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.