=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871895086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLADIMHOME INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2010
-----------------------------------------------------
Last Update Date | 11/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 W MIDDLE ST SUITE A
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48118-1293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-433-9007
-----------------------------------------------------
Fax | 734-433-9744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 W MIDDLE ST SUITE A
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48118-1293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-433-9007
-----------------------------------------------------
Fax | 734-433-9744
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. NICOLE A GREER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 734-433-9007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 01923R
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------