MEDICARE: MICHIGAN VISITING NURSE CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1619929460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN VISITING NURSE CORPORATION

Provider Business Mailing Address
First Line	:	2850 S INDUSTRIAL HWY
Second Line	:	SUITE 75A
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-6796
Country	:	US
Telephone Number	:	734-677-4515
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 S INDUSTRIAL HWY
Second Line	:	SUITE 75A
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-6796
Country	:	US
Telephone Number	:	734-677-4515
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MS. KATHLEEN S GOLD
Credential	:
Telephone Number	:	734-975-3095

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/22/2020

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