=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841575891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAZY MINDFUL CARE GIVING AGENCY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2011
-----------------------------------------------------
Last Update Date | 02/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21700 GREENFIELD STE 264
-----------------------------------------------------
City | OAKPARK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-850-7110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21700 GREENFIELD STE 264
-----------------------------------------------------
City | OAKPARK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-850-7110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. CHINYERE SORONNADI
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 248-850-7110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------