Healthcare Provider Details

I. General information

NPI: 1639638240
Provider Name (Legal Business Name): WYCLIFFE OPIYO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 ASBURY AVE
KALAMAZOO MI
49048-1335
US

IV. Provider business mailing address

2901 ASBURY AVE
KALAMAZOO MI
49048-1335
US

V. Phone/Fax

Practice location:
  • Phone: 817-781-6512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: