# RESTIVA CARE PROVIDERS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902629439
- **Authorized official:** CHANNIE ODAMS LPN (ADMINISTRATOR/OWNER)
- **Authorized official phone:** (734) 521-1577

## Contact information

- **Practice address:** 40075 EATON STREET, APT. 203, CANTON, MI 48187
- **Practice address phone:** (810) 588-1595
- **Mailing address:** 847 SUMPTER ROAD, \#436, BELLEVILLE, MI 48111
- **Mailing address phone:** (810) 588-1595

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | — | NULL | — |
| 163W00000X | Registered Nurse | — | — | — |
| 163WH0200X | Home Health Registered Nurse | — | NULL | — |
| 163WW0000X | Wound Care Registered Nurse | — | NULL | — |
| 163WW0000X | Wound Care Registered Nurse | — | — | — |
| 164W00000X | Licensed Practical Nurse | — | NULL | — |
| 164W00000X | Licensed Practical Nurse | — | — | — |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | — |
| 171M00000X | Case Manager/Care Coordinator | — | — | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 251F00000X | Home Infusion Agency | — | NULL | — |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 332U00000X | Home Delivered Meals | — | NULL | — |
| 347C00000X | Private Vehicle | — | NULL | — |
| 372500000X | Chore Provider | — | NULL | — |
| 372500000X | Chore Provider | — | — | — |
| 372600000X | Adult Companion | — | NULL | — |
| 372600000X | Adult Companion | — | — | — |
| 385H00000X | Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 11/04/2024
- **Last updated:** 11/13/2024