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Organization

RESTIVA CARE PROVIDERS LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHANNIE ODAMS LPN (ADMINISTRATOR/OWNER)
(734) 521-1577
Entity
Organization

Contact information

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

Taxonomy

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

Other

Enumeration date
11/04/2024
Last updated
11/13/2024
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