SHAWNA DAVELLA DIETRICK (NPI# 1154955219) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154955219 |
| Entity Type | Individual |
| Full Name | SHAWNA DAVELLA DIETRICK |
| Practice Address |
35675 Garner St Romulus MI 48174-4129 |
| Mailing Address |
Po Box 74083 Romulus MI 48174-0083 |
| Practice Telephone | 8103087991 |
| Mailing Telephone | 8103087991 |
| Enumeration Date | 2020-02-27 |
| Last Update Date | 2020-02-27 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 385HR2065X |
Respite Care Specialization: Respite Care, Physical Disabilities, Child |
D362765135841 | MI | Respite Care Facility |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | IDENTIFICATION | D362765135841 | 01 |
| Street Address |
35675 GARNER ST |
| City | ROMULUS |
| State | MI |
| Zip Code | 48174-4129 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417447947 | Pamela Ann Kaczor | Nurse Practitioner | 28721 Northline Rd, Romulus, MI 48174 | 2018-05-10 |
| 1750806469 | Demetrius Kirk | Registered Nurse | 30075 Spain, Romulus, MI 48174 | 2017-08-03 |
| 1982133302 | Tamika Lloyd | Non-emergency Medical Transport (VAN) | 6002 Bay Hill Ct, Romulus, MI 48174 | 2017-06-08 |
| 1811346422 | Maxine Vernette Hawk | Nurse Practitioner | 39061 Commons Dr., Romulus, MI 48174 | 2016-06-06 |
| 1164880282 | Lacara Gilmore | Counselor | 15056 Colbert St, 03, Romulus, MI 48174 | 2016-02-03 |
| 1982082632 | Kristin Michelle Rhan | Licensed Practical Nurse | 10195 Diane St. Apt302, Romulus, MI 48174 | 2015-05-14 |
| 1790176790 | Dylan Marie Feil | Social Worker | 37300 Wick Rd, Romulus, MI 48174 | 2015-02-11 |
| 1285053710 | Janeise Daniels | Licensed Practical Nurse | 9426 Lisa, Romulus, MI 48174 | 2014-04-14 |
| 1699119461 | James A. Lee | Counselor | C/o Reliance Counseling, LLC, 11126 Wayne Rd., Romulus, MI 48174 | 2013-04-24 |
| 1922302132 | Covenant To Care, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 37292 Mcbride, Romulus, MI 48174 | 2011-01-03 |
| Find all providers in zip 48174 | ||||
| Taxonomy Code | 385HR2065X |
| Grouping | Respite Care Facility |
| Classification | Respite Care |
| Specialization | Respite Care, Physical Disabilities, Child |
| A facility or distinct part of a facility that providers short term, residential care to children, diagnosed with complex or profound disabilities as respite for the regular caregivers. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437635976 | Scriptures Home Care | Respite Care | 49251 Schoenherr Rd, Shelby Township, MI 48315-3860 | 2018-07-18 |
| 1023489895 | Chitter Chatter, P.c | Respite Care | 1000 Republic Dr, Allen Park, MI 48101-3658 | 2015-10-19 |
| 1225389141 | Family Health Center & Rehab Inc | Respite Care | 9743 Conant St, Hamtramck, MI 48212-3306 | 2012-10-02 |
| 1215233549 | Regal Services | Respite Care | 9427 Conant St, Hamtramck, MI 48212-3689 | 2011-02-03 |
| 1326246083 | Milestone Rehab Services, Inc. | Respite Care | 5820 N Lilley Rd, Suite 1., Canton, MI 48187-3686 | 2007-07-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.