Provider Demographics
NPI:1871058321
Name:NIA HOME HEALTH
Entity type:Organization
Organization Name:NIA HOME HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:REANETTA
Authorized Official - Middle Name:CHARESE
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-808-0331
Mailing Address - Street 1:1015 HENRIETTA ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-4112
Mailing Address - Country:US
Mailing Address - Phone:248-808-0331
Mailing Address - Fax:
Practice Address - Street 1:7310 WOODWARD AVE STE 600
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3165
Practice Address - Country:US
Practice Address - Phone:313-288-8253
Practice Address - Fax:313-871-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health