Healthcare Provider Details

I. General information

NPI: 1871058321
Provider Name (Legal Business Name): NIA HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 02/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 WOODWARD AVE STE 600
DETROIT MI
48202-3165
US

IV. Provider business mailing address

1015 HENRIETTA ST
BIRMINGHAM MI
48009-4112
US

V. Phone/Fax

Practice location:
  • Phone: 313-288-8253
  • Fax: 313-871-2016
Mailing address:
  • Phone: 248-808-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: REANETTA CHARESE JAMES
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 248-808-0331