Provider Demographics
NPI:1770830465
Name:MCCLAIN, TONYA DELITA (AOP, HHA)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:DELITA
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:AOP, HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 PRINCETON AVE
Mailing Address - Street 2:APT.1
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3416
Mailing Address - Country:US
Mailing Address - Phone:269-779-5696
Mailing Address - Fax:
Practice Address - Street 1:916 PRINCETON AVE
Practice Address - Street 2:APT.1
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3416
Practice Address - Country:US
Practice Address - Phone:269-779-5696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care