Basic Information
Provider Information
NPI: 1558969915
EntityType: 2
ReplacementNPI:  
OrganizationName: MISSION POINT OF WOODWARD LLC
LastName:  
FirstName:  
MiddleName:  
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Credential:  
OtherOrganizationName:  
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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: 9146 WOODWARD AVE
Address2:  
City: DETROIT
State: MI
PostalCode: 482021612
CountryCode: US
TelephoneNumber: 3138751263
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/16/2020
LastUpdateDate: 10/16/2020
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: MALI
AuthorizedOfficialFirstName: HARI
AuthorizedOfficialMiddleName: S (ROGER)
AuthorizedOfficialTitleorPosition: SOLE MEMBER
AuthorizedOfficialTelephone: 2489405390
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix: II
AuthorizedOfficialCredential:  
NPICertificationDate: 10/16/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X  Y Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

No ID Information.


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