Healthcare Provider Details

I. General information

NPI: 1063224988
Provider Name (Legal Business Name): MTB HOMES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 WALDON RD
CLARKSTON MI
48346-2237
US

IV. Provider business mailing address

15093 OAK KNOLL CT
STERLING HEIGHTS MI
48312-5779
US

V. Phone/Fax

Practice location:
  • Phone: 989-402-8039
  • Fax:
Mailing address:
  • Phone: 989-402-8039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JOANITA N MUTEBI
Title or Position: ADMINISTRATOR
Credential:
Phone: 989-402-8039