Healthcare Provider Details

I. General information

NPI: 1053899906
Provider Name (Legal Business Name): CHRISTINA RAE GRZADZINSKI PCR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25584 COLLINGWOOD ST
ROSEVILLE MI
48066-3956
US

IV. Provider business mailing address

25584 COLLINGWOOD ST
ROSEVILLE MI
48066-3956
US

V. Phone/Fax

Practice location:
  • Phone: 248-242-2635
  • Fax:
Mailing address:
  • Phone: 248-242-2635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number8220747
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: