Healthcare Provider Details

I. General information

NPI: 1669965299
Provider Name (Legal Business Name): WELLBRIDGE OF CLARKSTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 CLARKSTON ROAD
INDEPENDENCE TOWNSHIP MI
48348
US

IV. Provider business mailing address

10503 CITATION DR STE 100
BRIGHTON MI
48116-6551
US

V. Phone/Fax

Practice location:
  • Phone: 810-534-0150
  • Fax:
Mailing address:
  • Phone: 810-534-0150
  • 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: MR. TODD SANGSTER
Title or Position: CFO
Credential:
Phone: 810-534-0150