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General NPI Number Information
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NPI Number | 1457740714
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Entity Type | Organization
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Legal Business Name | GLENDALE ATTENDANT CARE AGENCY
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 01/10/2015
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Provider Practice Location Address
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Address Line | 4302 W BUENA VISTA ST
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City | DETROIT
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State | MI
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Zip | 48238-3276
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Country | US
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Telephone | 313-212-8782
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Fax |
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Provider Business Mailing Address
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Address Line | 4302 W BUENA VISTA ST
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City | DETROIT
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State | MI
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Zip | 48238-3276
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Country | US
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Telephone | 313-212-8782
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Fax |
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Authorized Official
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Title or Position | HOME HEALTH AIDE
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Name | MS. BRANDI CIERRA BARNES
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Credential |
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Telephone | 313-212-8782
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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 | NO LICENSE REQUIRED
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License Number State | MI
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