Provider Demographics
NPI:1710786074
Name:DOMUS SECRETA LLC.
Entity type:Organization
Organization Name:DOMUS SECRETA LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIDEJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:866-703-5586
Mailing Address - Street 1:9029 PATTON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1621
Mailing Address - Country:US
Mailing Address - Phone:866-703-5586
Mailing Address - Fax:
Practice Address - Street 1:9029 PATTON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1621
Practice Address - Country:US
Practice Address - Phone:866-703-5586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care