=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407081672
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RELEVAR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2009
-----------------------------------------------------
Last Update Date | 11/21/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8300 HALL ROAD SUITE 100
-----------------------------------------------------
City | UTICA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48317-5506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-493-7677
-----------------------------------------------------
Fax | 586-493-7678
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8300 HALL ROAD SUITE 100
-----------------------------------------------------
City | UTICA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48317-5506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-493-7677
-----------------------------------------------------
Fax | 586-493-7678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. MISTY DELEGATO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 586-493-7677
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------