Healthcare Provider Details

I. General information

NPI: 1629009873
Provider Name (Legal Business Name): GREATER OAKLAND VISITING NURSE ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 W HURON ST
WATERFORD MI
48328-3727
US

IV. Provider business mailing address

959 W HURON ST
WATERFORD MI
48328-3727
US

V. Phone/Fax

Practice location:
  • Phone: 248-683-1770
  • Fax: 248-683-1774
Mailing address:
  • Phone: 248-683-1770
  • Fax: 248-683-1774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number237013
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number237013
License Number StateMI

VIII. Authorized Official

Name: MRS. DONNA M FISHMAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.S.N., M.S.B.A.
Phone: 248-683-1770