Healthcare Provider Details

I. General information

NPI: 1417823006
Provider Name (Legal Business Name): NUTRITION CONNECTION GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/26/2025
Certification Date: 10/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25150 FORD RD STE 200
DEARBORN HEIGHTS MI
48127-3163
US

IV. Provider business mailing address

25150 FORD RD STE 200
DEARBORN HEIGHTS MI
48127-3163
US

V. Phone/Fax

Practice location:
  • Phone: 313-284-0822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: MONA FAKIH
Title or Position: OWNER
Credential:
Phone: 313-284-0822