Healthcare Provider Details

I. General information

NPI: 1902786973
Provider Name (Legal Business Name): MIIKO GROUP HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 MONUMENT
ANN ARBOR MI
48108-2247
US

IV. Provider business mailing address

3237 MONUMENT
ANN ARBOR MI
48108-2247
US

V. Phone/Fax

Practice location:
  • Phone: 734-276-1434
  • Fax:
Mailing address:
  • Phone: 734-276-1434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. FATIMA N HASSAN
Title or Position: MANAGER
Credential:
Phone: 734-276-1434