Healthcare Provider Details

I. General information

NPI: 1922467026
Provider Name (Legal Business Name): BODY HEALING SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38910 MINTON AVE
LIVONIA MI
48150-3322
US

IV. Provider business mailing address

38910 MINTON AVE
LIVONIA MI
48150-3322
US

V. Phone/Fax

Practice location:
  • Phone: 248-890-8883
  • Fax: 888-345-0261
Mailing address:
  • Phone: 248-890-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: KENNETH GRANDON
Title or Position: OWNER
Credential: LMT, GCFP
Phone: 248-890-8883