Provider Demographics
NPI:1689934671
Name:VIETNAM VETERANS OF MICHIGAN INC.
Entity Type:Organization
Organization Name:VIETNAM VETERANS OF MICHIGAN INC.
Other - Org Name:FRASER HOUSE FOR VETERANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:734-216-4862
Mailing Address - Street 1:8933 MOON RD
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-9452
Mailing Address - Country:US
Mailing Address - Phone:734-216-4862
Mailing Address - Fax:
Practice Address - Street 1:15465 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-2080
Practice Address - Country:US
Practice Address - Phone:586-415-2861
Practice Address - Fax:586-415-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X, 253J00000X
MI347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253J00000XAgenciesFoster Care Agency
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate Vehicle