Healthcare Provider Details

I. General information

NPI: 1699620773
Provider Name (Legal Business Name): VINCULUM CARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 PINE GROVE AVE
PORT HURON MI
48060-3370
US

IV. Provider business mailing address

1530 PINE GROVE AVE
PORT HURON MI
48060-3370
US

V. Phone/Fax

Practice location:
  • Phone: 810-357-8792
  • Fax: 810-512-7725
Mailing address:
  • Phone: 810-357-8792
  • Fax: 810-512-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ELIA EJAZ HUSSAIN
Title or Position: CEO
Credential:
Phone: 810-357-8792