Provider Demographics
NPI:1699760363
Name:VISITING NURSE EXTRA CARE
Entity type:Organization
Organization Name:VISITING NURSE EXTRA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLADEEN
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:419-291-7847
Mailing Address - Street 1:383 W DUSSEL DR
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1632
Mailing Address - Country:US
Mailing Address - Phone:419-897-2800
Mailing Address - Fax:419-897-2810
Practice Address - Street 1:383 W DUSSEL DR
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1632
Practice Address - Country:US
Practice Address - Phone:419-897-2800
Practice Address - Fax:419-897-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI141096OtherTRINITY HEALTH PLANS
MI4210534Medicaid
OH0865158Medicaid
MI141096OtherCARE CHOICES
OH0183117Medicaid
MI141096OtherCARE CHOICES
OH0183117Medicaid
OH0865158Medicaid
MI141096OtherCARE CHOICES