=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386910958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NURSES ON WHEELS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2012
-----------------------------------------------------
Last Update Date | 03/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11790 BEACONSFIELD ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48224-4106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-718-3155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11790 BEACONSFIELD ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48224-4106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-718-3155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/DIRECTOR
-----------------------------------------------------
Name | MRS. ARLENE PORCHIA
-----------------------------------------------------
Credential | R.N
-----------------------------------------------------
Telephone | 313-718-3155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | 4704241852
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------