Healthcare Provider Details

I. General information

NPI: 1518419043
Provider Name (Legal Business Name): ALMA CARE VISITING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11352 GABRIEL ST
ROMULUS MI
48174-1431
US

IV. Provider business mailing address

11352 GABRIEL ST
ROMULUS MI
48174-1431
US

V. Phone/Fax

Practice location:
  • Phone: 313-575-8111
  • Fax: 734-713-6709
Mailing address:
  • Phone: 313-575-8111
  • Fax: 734-713-6709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601007382
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number01864-1/8963899
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARISLENE DELVA
Title or Position: ADMINISTRATOR
Credential: PA
Phone: 313-575-8111