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General NPI Number Information
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NPI Number | 1558712331
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Entity Type | Organization
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Legal Business Name | MELVINA CARE LLC.
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 20561 HEYDEN ST
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City | DETROIT
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State | MI
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Zip | 48219-1424
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Country | US
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Telephone | 248-277-2233
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Fax |
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Provider Business Mailing Address
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Address Line | 20561 HEYDEN ST
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City | DETROIT
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State | MI
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Zip | 48219-1424
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOL MBR
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Name | MRS. SHANIKA MULDROW
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Credential |
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Telephone | 248-277-2233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 473104147
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License Number State | MI
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