MEDICARE: VINCULUM CARE FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	163WC0400X	Case Management Registered Nurse
2	261QA0600X	Adult Day Care Clinic/Center
3	261QR1300X	Rural Health Clinic/Center
4	385H00000X	Respite Care
5	251E00000X	Home Health Agency
6	251J00000X	Nursing Care Agency
7	104100000X	Social Worker

General Provider Information

NPI Number	:	1699620773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINCULUM CARE FOUNDATION

Provider Business Mailing Address
First Line	:	1530 PINE GROVE AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3370
Country	:	US
Telephone Number	:	810-357-8792
Fax Number	:	810-512-7725

Provider Business Practice Location Address
First Line	:	1530 PINE GROVE AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3370
Country	:	US
Telephone Number	:	810-357-8792
Fax Number	:	810-512-7725

Authorized Official
Title or Position	:	CEO
Name	:	ELIA EJAZ HUSSAIN
Credential	:
Telephone Number	:	810-357-8792

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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Directions to “VINCULUM CARE FOUNDATION ” Practice Location

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