Provider Demographics
NPI:1477269645
Name:RELIABLE SOURCE STAFFING AGENCY
Entity Type:Organization
Organization Name:RELIABLE SOURCE STAFFING AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:RN/OWNER
Authorized Official - Phone:810-986-3207
Mailing Address - Street 1:1336 MAXSON ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-4329
Mailing Address - Country:US
Mailing Address - Phone:586-894-2067
Mailing Address - Fax:
Practice Address - Street 1:1336 MAXSON ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4329
Practice Address - Country:US
Practice Address - Phone:586-894-2067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health