Healthcare Provider Details

I. General information

NPI: 1992310957
Provider Name (Legal Business Name): MISSION POINT OF ISHPEMING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 STONEVILLE RD
ISHPEMING MI
49849-2921
US

IV. Provider business mailing address

30700 TELEGRAPH RD STE 1510
BINGHAM FARMS MI
48025-5802
US

V. Phone/Fax

Practice location:
  • Phone: 906-485-1073
  • Fax:
Mailing address:
  • Phone: 248-940-5390
  • Fax: 248-792-9115

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: HARI S (ROGER) MALI
Title or Position: SOLE MEMBER
Credential:
Phone: 248-940-5390