Provider Demographics
NPI:1194897538
Name:VISITING NURSE ASSOCIATION OF SOUTHEAST MICHIGAN
Entity type:Organization
Organization Name:VISITING NURSE ASSOCIATION OF SOUTHEAST MICHIGAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-967-9611
Mailing Address - Street 1:25900 GREENFIELD RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1292
Mailing Address - Country:US
Mailing Address - Phone:248-967-8719
Mailing Address - Fax:248-967-8761
Practice Address - Street 1:25900 GREENFIELD RD
Practice Address - Street 2:SUITE 600
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1292
Practice Address - Country:US
Practice Address - Phone:248-967-8719
Practice Address - Fax:248-967-8761
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISITING NURSE ASSOCIATION OF SOUTHEAST MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-14
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI833512251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3140490Medicaid
MI08750OtherBLUE CROSS BLUE SHIELD OF
MI3140490Medicaid