Healthcare Provider Details

I. General information

NPI: 1902806003
Provider Name (Legal Business Name): ABOVE & BEYOND QUALITY FOR WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 RODD ST
MIDLAND MI
48640-4451
US

IV. Provider business mailing address

2720 RODD ST
MIDLAND MI
48640-4451
US

V. Phone/Fax

Practice location:
  • Phone: 989-698-0597
  • Fax: 989-698-3105
Mailing address:
  • Phone: 989-698-0597
  • Fax: 989-698-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704231021
License Number StateMI

VIII. Authorized Official

Name: MRS. LOIS KATIE NEWMAN
Title or Position: RN/ADMINISTRATOR
Credential: RN
Phone: 989-698-0597