Healthcare Provider Details

I. General information

NPI: 1205622842
Provider Name (Legal Business Name): OPTALIS BLOOMFIELD HILLS OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 N ADAMS RD
BLOOMFIELD HILLS MI
48304-3786
US

IV. Provider business mailing address

2975 N ADAMS RD
BLOOMFIELD HILLS MI
48304-3786
US

V. Phone/Fax

Practice location:
  • Phone: 248-645-2900
  • Fax: 248-433-1415
Mailing address:
  • Phone: 248-645-2900
  • Fax: 248-433-1415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: RAJ PATEL
Title or Position: CEO
Credential:
Phone: 248-692-4355