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General NPI Number Information
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NPI Number | 1245740190
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Entity Type | Organization
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Legal Business Name | VICKSBURG HOME CARE
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 10/05/2017
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Provider Practice Location Address
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Address Line | 3075 E VW AVE
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City | VICKSBURG
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State | MI
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Zip | 49097-7739
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Country | US
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Telephone | 269-492-8423
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Fax | 866-854-7795
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Provider Business Mailing Address
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Address Line | PO BOX 606
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City | SCHOOLCRAFT
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State | MI
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Zip | 49087-0606
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Country | US
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Telephone | 269-492-8423
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Fax | 866-854-7795
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Authorized Official
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Title or Position | CEO
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Name | MS. TRACY CONVERSE
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Credential |
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Telephone | 269-492-8423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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