Provider Demographics
NPI:1518419043
Name:ALMA CARE VISITING SERVICES
Entity Type:Organization
Organization Name:ALMA CARE VISITING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELVA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:313-575-8111
Mailing Address - Street 1:11352 GABRIEL ST
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-1431
Mailing Address - Country:US
Mailing Address - Phone:313-575-8111
Mailing Address - Fax:734-713-6709
Practice Address - Street 1:11352 GABRIEL ST
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-1431
Practice Address - Country:US
Practice Address - Phone:313-575-8111
Practice Address - Fax:734-713-6709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207QA0505X, 207QG0300X, 207R00000X
MI5601007382363AM0700X
NY01864-1/8963899363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty