Provider Demographics
NPI:1023864527
Name:KIND HOLISTIC AND PRIMARY CARE PROVIDERS
Entity type:Organization
Organization Name:KIND HOLISTIC AND PRIMARY CARE PROVIDERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHALINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:313-308-6154
Mailing Address - Street 1:43416 HEATHERFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-4953
Mailing Address - Country:US
Mailing Address - Phone:313-308-6154
Mailing Address - Fax:
Practice Address - Street 1:43416 HEATHERFIELD BLVD
Practice Address - Street 2:
Practice Address - City:VAN BUREN TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48111-4953
Practice Address - Country:US
Practice Address - Phone:313-308-6154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty