Healthcare Provider Details

I. General information

NPI: 1356285282
Provider Name (Legal Business Name): MICHIGAN BS OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21630 HESSEL AVE # 1230
DETROIT MI
48219-1230
US

IV. Provider business mailing address

2360 LAKEWOOD RD STE 2
TOMS RIVER NJ
08755-1929
US

V. Phone/Fax

Practice location:
  • Phone: 313-534-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MENACHEM P KOFMAN
Title or Position: MANAGER
Credential:
Phone: 732-908-1218