Provider Demographics
NPI:1508202243
Name:VALANA HEALTH CARE
Entity Type:Organization
Organization Name:VALANA HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:LATONYA
Authorized Official - Last Name:CLAIBORUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-968-3330
Mailing Address - Street 1:22000 GREENFIELD RD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2500
Mailing Address - Country:US
Mailing Address - Phone:248-968-3330
Mailing Address - Fax:248-968-3132
Practice Address - Street 1:22000 GREENFIELD RD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2500
Practice Address - Country:US
Practice Address - Phone:248-968-3330
Practice Address - Fax:248-968-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010066401261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service