=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992823967
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHS OF GREATER DETROIT,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2007
-----------------------------------------------------
Last Update Date | 08/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19830 JAMES COUZENS FWY SUITE A
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48235-1938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-341-8810
-----------------------------------------------------
Fax | 313-341-8820
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19830 JAMES COUZENS FWY SUITE A
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48235-1938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-341-8810
-----------------------------------------------------
Fax | 313-341-8820
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. KATHY R HARRIS
-----------------------------------------------------
Credential | R.N. PHD
-----------------------------------------------------
Telephone | 313-341-8810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC0400X
-----------------------------------------------------
Taxonomy Name | Case Management Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------