Healthcare Provider Details

I. General information

NPI: 1457755522
Provider Name (Legal Business Name): GIVA TILLMAN-ADKINS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 PUCKER STREET DR
NILES MI
49120-1192
US

IV. Provider business mailing address

1723 PUCKER STREET DR
NILES MI
49120-1192
US

V. Phone/Fax

Practice location:
  • Phone: 269-697-9556
  • Fax: 269-683-5280
Mailing address:
  • Phone: 269-697-9556
  • Fax: 269-683-5280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: GIVA ONETA TILLMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 269-697-9556