Provider Demographics
NPI:1467919688
Name:FLOWERS, OLIVIA JEAN
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JEAN
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2922
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-0952
Mailing Address - Country:US
Mailing Address - Phone:313-656-4077
Mailing Address - Fax:
Practice Address - Street 1:119 PINGREE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2021
Practice Address - Country:US
Practice Address - Phone:313-656-4077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1742000000X174200000X
MI177F000000X177F00000X
MI251J0000X251J00000X
MI251S0000000X251S00000X
MI3105000000X310500000X
MI315P000000X315P00000X
MI3439000000X343900000X
MIAM820079488253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6306779Medicaid