Provider Demographics
NPI:1639612963
Name:PHARR-ROSS, ALITA
Entity Type:Individual
Prefix:
First Name:ALITA
Middle Name:
Last Name:PHARR-ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45332 BURGUNDY DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-6037
Mailing Address - Country:US
Mailing Address - Phone:313-643-8590
Mailing Address - Fax:
Practice Address - Street 1:45332 BURGUNDY DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-6037
Practice Address - Country:US
Practice Address - Phone:313-643-8590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI138170374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23238OtherHOME HELP PROVIDER