Basic Information
| Provider Information | |||||||||
| NPI: | 1124297403 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VISITING NURSE & HOSPICE SERVICES OF SOUTHWEST MICHIGAN | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BORGESS VISITING NURSE & HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 348 N BURDICK ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490073830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693431396 | ||||||||
| FaxNumber: | 2693828006 | ||||||||
| Practice Location | |||||||||
| Address1: | 348 N BURDICK ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490073830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693431396 | ||||||||
| FaxNumber: | 2693828006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2008 | ||||||||
| LastUpdateDate: | 02/28/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DALTON | ||||||||
| AuthorizedOfficialFirstName: | VAL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2693431396 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SH0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 0C91176 | 01 | MI | BCBSMI | OTHER |