Provider Demographics
NPI:1629009873
Name:GREATER OAKLAND VISITING NURSE ASSOCIATION, INC.
Entity Type:Organization
Organization Name:GREATER OAKLAND VISITING NURSE ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, MSBA
Authorized Official - Phone:248-683-1770
Mailing Address - Street 1:959 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3727
Mailing Address - Country:US
Mailing Address - Phone:248-683-1770
Mailing Address - Fax:248-683-1774
Practice Address - Street 1:959 W HURON ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3727
Practice Address - Country:US
Practice Address - Phone:248-683-1770
Practice Address - Fax:248-683-1774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI237013251E00000X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E027OtherBLUE CROSS PROVIDER NO.
MI000000004857OtherCAPE INSURRANCE
MIM017039OtherCHAMPUS PROVIDER NO.
MI125910OtherGREAT LAKES HLTH PROVID.
MI5173856Medicaid
MI0E027OtherBLUE CROSS PROVIDER NO.