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General NPI Number Information
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NPI Number | 1144906538
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Entity Type | Organization
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Legal Business Name | VINCULUM CARE LLC
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Dates
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Enumeration Date | 06/22/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 5316 LAKESHORE RD
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3118
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Country | US
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Telephone | 810-357-8792
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Fax |
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Provider Business Mailing Address
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Address Line | 5316 LAKESHORE RD
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3118
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Country | US
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Telephone | 810-357-8792
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ELIA EJAZ HUSSAIN
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Credential |
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Telephone | 810-357-8792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 163WH1000X
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Taxonomy Name | Hospice Registered Nurse
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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