Healthcare Provider Details

I. General information

NPI: 1538063797
Provider Name (Legal Business Name): GAVIN & COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23638 COACH LIGHT DR
SOUTHFIELD MI
48075-3670
US

IV. Provider business mailing address

23638 COACH LIGHT DR
SOUTHFIELD MI
48075-3670
US

V. Phone/Fax

Practice location:
  • Phone: 248-979-4551
  • Fax:
Mailing address:
  • Phone: 248-979-4551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CAMILLE L GAVIN
Title or Position: CEO
Credential: NURSE
Phone: 248-979-4551