Provider Demographics
NPI:1104439033
Name:OTEVWA HOMES INC
Entity type:Organization
Organization Name:OTEVWA HOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIVE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVWARAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-690-0667
Mailing Address - Street 1:6556 RUSTIC RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-4956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6556 RUSTIC RIDGE TRL
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-4956
Practice Address - Country:US
Practice Address - Phone:313-690-0667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty