Provider Demographics
NPI:1720097678
Name:GRAY, ARBELLA VENNETTE
Entity Type:Individual
Prefix:MS
First Name:ARBELLA
Middle Name:VENNETTE
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BELLA'S
Other - Middle Name:BUDDIES
Other - Last Name:SENIOR CARE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:22674 N. KANE ST.
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2560
Mailing Address - Country:US
Mailing Address - Phone:313-532-8924
Mailing Address - Fax:
Practice Address - Street 1:22674 N KANE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-2560
Practice Address - Country:US
Practice Address - Phone:313-532-8924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered374U00000XNursing Service Related ProvidersHome Health Aide
Not Answered376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11231976OtherMARKETING ID