Healthcare Provider Details

I. General information

NPI: 1457996449
Provider Name (Legal Business Name): ACCORDIA SENIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20027 BURGESS
DETROIT MI
48219-1367
US

IV. Provider business mailing address

22503 GRAND RIVER AVE UNIT 19516
DETROIT MI
48219-5025
US

V. Phone/Fax

Practice location:
  • Phone: 248-907-3393
  • Fax:
Mailing address:
  • Phone: 248-907-3393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JACQUELINE MARTIN-EDWARD
Title or Position: PRESIDENT
Credential: RN, CCM
Phone: 248-907-3393