Provider Demographics
NPI:1831395789
Name:NIVYA LLC
Entity type:Organization
Organization Name:NIVYA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBONELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-202-3329
Mailing Address - Street 1:28091 DEQUINDRE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3047
Mailing Address - Country:US
Mailing Address - Phone:248-399-5151
Mailing Address - Fax:248-399-5153
Practice Address - Street 1:28091 DEQUINDRE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3047
Practice Address - Country:US
Practice Address - Phone:248-399-5151
Practice Address - Fax:248-399-5153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-7739OtherCCN