Healthcare Provider Details

I. General information

NPI: 1619149986
Provider Name (Legal Business Name): 211 GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21901 HARPER AVE
SAINT CLAIR SHORES MI
48080-2217
US

IV. Provider business mailing address

21901 HARPER AVE
SAINT CLAIR SHORES MI
48080-2217
US

V. Phone/Fax

Practice location:
  • Phone: 586-473-6188
  • Fax: 586-473-6199
Mailing address:
  • Phone: 586-473-6188
  • Fax: 586-473-6199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. SWADIE OKON
Title or Position: CFO
Credential:
Phone: 586-473-6188