Healthcare Provider Details

I. General information

NPI: 1467919688
Provider Name (Legal Business Name): OLIVIA JEAN FLOWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2019
Last Update Date: 02/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 PINGREE ST
DETROIT MI
48202-2021
US

IV. Provider business mailing address

PO BOX 2922
DETROIT MI
48202-0952
US

V. Phone/Fax

Practice location:
  • Phone: 313-656-4077
  • Fax:
Mailing address:
  • Phone: 313-656-4077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number1742000000X
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number177F000000X
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number251J0000X
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number251S0000000X
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number3105000000X
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number315P000000X
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number3439000000X
License Number StateMI
# 8
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberAM820079488
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: