NPIMap

Organization Active NPI

Personalize Home Care Services, LLC.

  • Home Health Agency
  • Lathrup Village, MI
National Provider Identifier
1306888714
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PERSONALIZE HOME CARE SERVICES, LLC.
Practice address
28021 Southfield Rd Ste 200
Lathrup Village, MI 48076-2816
Phone
(248) 621-1111
Fax
(248) 621-2222
NPI assigned
Jun 11, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mrs. Marlon Arthur Burt
Title
Vice President
Phone
(248) 621-1111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

28021 Southfield Rd Ste 200
Lathrup Village, MI 48076-2816

Mailing address

28021 Southfield Rd Ste 200
Lathrup Village, MI 48076-2816
Phone (248) 621-1111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070730000420 MI Part A Provider - Home Health Agency 3971516600 Practice locations: Lathrup Village, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306888714. Details of each certification follow.

Home health agency certification: CCN 237674

Legal name
PERSONALIZE HOME CARE SERVICES, LLC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 23, 2007
Last certification
Feb 14, 2013
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Oct 20, 2005 in MI
Enrollment address
28021 Southfield Rd
Ste 200
Lathrup Village, MI 48076-2816
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Personalize Home Care ServiceCCN 237674 · All quality measures
Overall star rating
2 of 5
Ownership
Proprietary
Certified
May 23, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

28021 Southfield Rd
Ste 200
Lathrup Village, MI 48076
Phone (248) 621-1111

29350 Southfield Rd
#44
Southfield, MI 48076
Phone (248) 569-9017

29350 Southfield Rd
Ste 129
Southfield, MI 48076
Phone (248) 569-9017

30233 Southfield Rd
Ste 219
Southfield, MI 48076
Phone (248) 593-1391

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Lavon Russell-Burt Individual 5% Or Greater Direct Ownership Interest Jan 1, 2016 20%
Corporate OfficerCeo Jan 1, 2020 100%
Marlon a Burt Individual 5% Or Greater Direct Ownership Interest Jan 1, 2020 60%
Corporate OfficerAdministrator Jan 1, 2020 100%
W-2 Managing EmployeeAdministrator Jul 17, 2006 100%
Arthur Burt III Individual Corporate Director Jul 17, 2006
Artell R Burt Individual 5% Or Greater Direct Ownership Interest Jan 1, 2020 20%
Corporate OfficerBoard Member Jan 1, 2020 20%

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1306888714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28021 SOUTHFIELD RD STE 200",
            "city": "LATHRUP VILLAGE",
            "state": "MI",
            "postal_code": "480762816",
            "telephone_number": "248-621-1111",
            "fax_number": "248-621-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28021 SOUTHFIELD RD STE 200",
            "city": "LATHRUP VILLAGE",
            "state": "MI",
            "postal_code": "480762816",
            "telephone_number": "248-621-1111",
            "fax_number": "248-621-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONALIZE HOME CARE SERVICES, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BURT",
        "authorized_official_first_name": "MARLON",
        "authorized_official_middle_name": "ARTHUR",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "248-621-1111",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lathrup Village, MI

Sources for this page

Verify at the official NPI Registry.