Healthcare Provider Details

I. General information

NPI: 1689934671
Provider Name (Legal Business Name): VIETNAM VETERANS OF MICHIGAN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15465 E 14 MILE RD
FRASER MI
48026-2080
US

IV. Provider business mailing address

8933 MOON RD
SALINE MI
48176-9452
US

V. Phone/Fax

Practice location:
  • Phone: 586-415-2861
  • Fax: 586-415-2860
Mailing address:
  • Phone: 734-216-4862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateMI

VIII. Authorized Official

Name: MS. SANDRA KAY WILSON
Title or Position: ADMISTRATOR
Credential: R.N.
Phone: 734-216-4862