Provider Demographics
NPI:1457996449
Name:ACCORDIA SENIOR SERVICES
Entity Type:Organization
Organization Name:ACCORDIA SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN-EDWARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CCM
Authorized Official - Phone:248-907-3393
Mailing Address - Street 1:22503 GRAND RIVER AVE UNIT 19516
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-5025
Mailing Address - Country:US
Mailing Address - Phone:248-907-3393
Mailing Address - Fax:
Practice Address - Street 1:20027 BURGESS
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1367
Practice Address - Country:US
Practice Address - Phone:248-907-3393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIVS0123503Medicaid