=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902806003
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABOVE & BEYOND QUALITY FOR WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2720 RODD ST
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48640-4451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-698-0597
-----------------------------------------------------
Fax | 989-698-3105
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2720 RODD ST
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48640-4451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-698-0597
-----------------------------------------------------
Fax | 989-698-3105
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN/ADMINISTRATOR
-----------------------------------------------------
Name | MRS. LOIS KATIE NEWMAN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 989-698-0597
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number | 4704231021
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------