Healthcare Provider Details

I. General information

NPI: 1679705685
Provider Name (Legal Business Name): ELDER CARE VISITING PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30075 GREENFIELD RD STE 101
SOUTHFIELD MI
48076-1523
US

IV. Provider business mailing address

30075 GREENFIELD RD STE 101
SOUTHFIELD MI
48076-1523
US

V. Phone/Fax

Practice location:
  • Phone: 248-594-4042
  • Fax: 248-594-4423
Mailing address:
  • Phone: 248-594-4042
  • Fax: 248-594-4423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MARSHA SHARLENE RUTHERFORD
Title or Position: MANAGING MEMEBER
Credential:
Phone: 248-594-4042