Healthcare Provider Details

I. General information

NPI: 1285878751
Provider Name (Legal Business Name): QCI NURSE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 COIT AVE NE
GRAND RAPIDS MI
49505-3383
US

IV. Provider business mailing address

2805 COIT AVE NE
GRAND RAPIDS MI
49505-3383
US

V. Phone/Fax

Practice location:
  • Phone: 616-365-9290
  • Fax: 616-365-9254
Mailing address:
  • Phone: 616-365-9290
  • Fax: 616-365-9254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTIAN JOHN VERA
Title or Position: CEO
Credential:
Phone: 616-365-9290