Provider Demographics
NPI:1760708184
Name:RIVERVIEW MACOMB HOME & ATTENDANT CARE, LLC
Entity Type:Organization
Organization Name:RIVERVIEW MACOMB HOME & ATTENDANT CARE, LLC
Other - Org Name:AVA ATTENDANT & HOME HEALTH SERVICES; AVA CARE & CASE MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:LACRAIG
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSCCM
Authorized Official - Phone:586-566-7343
Mailing Address - Street 1:PO BOX 183667
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48318-3667
Mailing Address - Country:US
Mailing Address - Phone:586-566-7343
Mailing Address - Fax:586-758-7801
Practice Address - Street 1:37060 GARFIELD RD
Practice Address - Street 2:STE C-1
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-3647
Practice Address - Country:US
Practice Address - Phone:586-566-7343
Practice Address - Fax:586-758-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704169199251B00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care