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General NPI Number Information
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NPI Number | 1487180980
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Entity Type | Organization
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Legal Business Name | NOLAN GREY HOME CARE AGENCY AND RESOURCE CENTER
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 4119 19TH ST
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City | ECORSE
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State | MI
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Zip | 48229-1244
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Country | US
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Telephone | 313-315-1526
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1165
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City | LINCOLN PARK
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State | MI
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Zip | 48146-1165
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Country | US
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Telephone | 313-315-1526
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ANITA R EDISON
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Credential |
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Telephone | 313-315-1526
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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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