Provider Demographics
NPI:1023219201
Name:VIRGINIA PARK CITIZENS SERVICE CORPORATION
Entity Type:Organization
Organization Name:VIRGINIA PARK CITIZENS SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUDE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-894-2830
Mailing Address - Street 1:8431 ROSA PARKS BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-2424
Mailing Address - Country:US
Mailing Address - Phone:313-894-2830
Mailing Address - Fax:313-894-0766
Practice Address - Street 1:8431 ROSA PARKS BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2424
Practice Address - Country:US
Practice Address - Phone:313-894-2830
Practice Address - Fax:313-894-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty