MEDICARE: GENEVIEVE DANDRIDGE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1912667841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENEVIEVE DANDRIDGE

Provider Business Mailing Address
First Line	:	PO BOX 3292
Second Line	:
City	:	CENTER LINE
State	:	MI
Zip	:	48015-0292
Country	:	US
Telephone Number	:	313-208-9484
Fax Number	:	800-717-0864

Provider Business Practice Location Address
First Line	:	24211 BLACKMAR AVE
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48091-1797
Country	:	US
Telephone Number	:	313-208-9484
Fax Number	:	800-717-0864

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2021
Last Update Date	:	12/20/2021

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Directions to “ GENEVIEVE DANDRIDGE ” Practice Location

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