Provider Demographics
NPI:1699010553
Name:MICHIGAN COMMUNITY VNA, LLC
Entity Type:Organization
Organization Name:MICHIGAN COMMUNITY VNA, LLC
Other - Org Name:MICHIGAN COMMUNITY VNA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-967-1440
Mailing Address - Street 1:30800 TELEGRAPH RD.
Mailing Address - Street 2:SUITE 1728
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025
Mailing Address - Country:US
Mailing Address - Phone:248-967-1440
Mailing Address - Fax:248-967-8741
Practice Address - Street 1:30800 TELEGRAPH RD.
Practice Address - Street 2:SUITE 1728
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025
Practice Address - Country:US
Practice Address - Phone:248-967-1440
Practice Address - Fax:248-967-8741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
237016Medicare Oscar/Certification