Healthcare Provider Details

I. General information

NPI: 1598461170
Provider Name (Legal Business Name): OPTALIS DEARBORN HEIGHTS OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26001 FORD RD
DEARBORN HEIGHTS MI
48127-2920
US

IV. Provider business mailing address

25500 MEADOWBROOK RD STE 230
NOVI MI
48375-1882
US

V. Phone/Fax

Practice location:
  • Phone: 313-274-4600
  • Fax:
Mailing address:
  • Phone: 248-692-4355
  • Fax: 248-692-4356

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: MARIANNE CONNER
Title or Position: VP FINANCE
Credential:
Phone: 248-277-5724