Healthcare Provider Details

I. General information

NPI: 1669392734
Provider Name (Legal Business Name): VILLAGE START MIHP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41243 WYNDCHASE BLVD
CANTON MI
48188-1996
US

IV. Provider business mailing address

41243 WYNDCHASE BLVD
CANTON MI
48188-1996
US

V. Phone/Fax

Practice location:
  • Phone: 734-773-8159
  • Fax:
Mailing address:
  • Phone: 734-773-8159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: OLIVIA SENYO TEHODA
Title or Position: OWNER
Credential: MSN
Phone: 734-773-8159