Interstate Home Health, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

INTERSTATE HOME HEALTH, LLC

Practice address

27177 Lahser Rd Ste 102
Southfield, MI 48034-8467

Phone

(248) 809-2500

Fax

(248) 809-3777

NPI assigned

Aug 1, 2019

Last updated

Apr 3, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Maysarsh Knouna

Title

President

Phone

(248) 809-2500

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114571692. Details of each certification follow.

• CCN 239321 Home health agency · Active · Details

Home health agency certification: CCN 239321

Legal name

INTERSTATE HOME HEALTH LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Sep 30, 2020

Last certification

Sep 30, 2020

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Apr 26, 2019 in MI

Enrollment address

27177 Lahser Rd
Ste 102
Southfield, MI 48034-4786

Listed as

Interstate Home HealthCCN 239321 · All quality measures

Ownership

Proprietary

Certified

Sep 30, 2020

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1564617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1114571692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27177 LAHSER RD STE 102",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480348467",
            "telephone_number": "248-809-2500",
            "fax_number": "248-809-3777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27177 LAHSER RD STE 102",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480348467",
            "telephone_number": "248-809-2500",
            "fax_number": "248-809-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERSTATE HOME HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-01",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "KNOUNA",
        "authorized_official_first_name": "MAYSARSH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-809-2500",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Southfield",
            "affiliation": "N",
            "endpointDescription": "office 1",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "27177 Lahser Rd Ste 102",
            "city": "Southfield",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480348467",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Home Health Agency in Southfield, MI
• Providers in Southfield, 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 Apr 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.