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General NPI Number Information
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NPI Number | 1962915132
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Entity Type | Organization
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Legal Business Name | VCCF HOME CARE LLC
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 27739 JEFFERSON AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-1309
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Country | US
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Telephone | 586-777-2115
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Fax | 313-731-1943
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Provider Business Mailing Address
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Address Line | 27739 JEFFERSON AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-1309
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Country | US
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Telephone | 586-777-2115
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Fax | 313-731-1943
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MARY BETH RYAN
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Credential |
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Telephone | 586-777-2115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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