Provider Demographics
NPI:1679705685
Name:ELDER CARE VISITING PHYSICIANS
Entity Type:Organization
Organization Name:ELDER CARE VISITING PHYSICIANS
Other - Org Name:ELDER CARE VP SERVICE LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING MEMEBER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:SHARLENE
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-594-4042
Mailing Address - Street 1:30075 GREENFIELD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1523
Mailing Address - Country:US
Mailing Address - Phone:248-594-4042
Mailing Address - Fax:248-594-4423
Practice Address - Street 1:30075 GREENFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1523
Practice Address - Country:US
Practice Address - Phone:248-594-4042
Practice Address - Fax:248-594-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty