Provider Demographics
NPI:1992040166
Name:MICHIGAN COMMUNITY WELLNESS VNA, LLC
Entity Type:Organization
Organization Name:MICHIGAN COMMUNITY WELLNESS VNA, LLC
Other - Org Name:
Other - Org Type:
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:248-967-8315
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:248-967-8315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
M16447Medicare Oscar/Certification