Basic Information
| Provider Information | |||||||||
| NPI: | 1316536790 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MISSION POINT OF WARREN LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30700 TELEGRAPH RD STE 1510 | ||||||||
| Address2: | |||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480255802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489405390 | ||||||||
| FaxNumber: | 2487929115 | ||||||||
| Practice Location | |||||||||
| Address1: | 11525 E 10 MILE RD | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480893802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867590700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2021 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | MALI | ||||||||
| AuthorizedOfficialFirstName: | HARI | ||||||||
| AuthorizedOfficialMiddleName: | S (ROGER) | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2489405390 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.