Provider Demographics
NPI:1548733512
Name:RESPITE CARE SERVICES EEMC
Entity type:Organization
Organization Name:RESPITE CARE SERVICES EEMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME CARE ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:MHMA
Authorized Official - Phone:810-233-0621
Mailing Address - Street 1:1701 LAUREL OAK DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2210
Mailing Address - Country:US
Mailing Address - Phone:810-233-0621
Mailing Address - Fax:
Practice Address - Street 1:1701 LAUREL OAK DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2210
Practice Address - Country:US
Practice Address - Phone:810-233-0621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIVS0082275OtherSIGMA VSS ID
MI8431278OtherSTATE OF MICHIGAN PROVIDER ID