Provider Demographics
NPI:1487180980
Name:NOLAN GREY HOME CARE AGENCY AND RESOURCE CENTER
Entity Type:Organization
Organization Name:NOLAN GREY HOME CARE AGENCY AND RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:EDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-315-1526
Mailing Address - Street 1:PO BOX 1165
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-1165
Mailing Address - Country:US
Mailing Address - Phone:313-315-1526
Mailing Address - Fax:
Practice Address - Street 1:4119 19TH ST
Practice Address - Street 2:
Practice Address - City:ECORSE
Practice Address - State:MI
Practice Address - Zip Code:48229-1244
Practice Address - Country:US
Practice Address - Phone:313-315-1526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care