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General NPI Number Information
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NPI Number | 1285354134
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Entity Type | Organization
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Legal Business Name | GREENVINE MEDICAL STAFFING GROUP
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | 35248 PALMER RD
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City | WESTLAND
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State | MI
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Zip | 48186-4458
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Country | US
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Telephone | 810-373-9387
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3164
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City | SOUTHFIELD
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State | MI
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Zip | 48037-3164
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Country | US
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Telephone | 810-373-9387
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | GEORGE WATSON
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Credential | BSME, MHA
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Telephone | 810-373-9387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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