1992170625 NPI number — SUFFICIENT GRACE HOME HEALTH CARE AGENCY LLC

Table of content: TUAN CHRISTOPHER TRAN M.D. (NPI 1124171541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992170625 NPI number — SUFFICIENT GRACE HOME HEALTH CARE AGENCY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUFFICIENT GRACE HOME HEALTH CARE AGENCY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992170625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8415 LA SALLE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48206-2445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-764-3057
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8415 LA SALLE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48206-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-764-3057
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/07/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
CARLITA
Authorized Official Middle Name:
CHANTE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
248-764-3057

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)