Healthcare Provider Details

I. General information

NPI: 1457480733
Provider Name (Legal Business Name): VISITING NURSE HOME SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25900 GREENFIELD RD SUITE 600
OAK PARK MI
48237-1292
US

IV. Provider business mailing address

25900 GREENFIELD RD SUITE 600
OAK PARK MI
48237-1292
US

V. Phone/Fax

Practice location:
  • Phone: 248-967-8719
  • Fax: 248-967-8761
Mailing address:
  • Phone: 248-967-8719
  • Fax: 248-967-8761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHLEEN HOLYCROSS
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 248-967-9620