Provider Demographics
NPI:1457740714
Name:GLENDALE ATTENDANT CARE AGENCY
Entity Type:Organization
Organization Name:GLENDALE ATTENDANT CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH AIDE
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:CIERRA
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-212-8782
Mailing Address - Street 1:4302 W BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-3276
Mailing Address - Country:US
Mailing Address - Phone:313-212-8782
Mailing Address - Fax:
Practice Address - Street 1:4302 W BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-3276
Practice Address - Country:US
Practice Address - Phone:313-212-8782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINO LICENSE REQUIRED253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care