Healthcare Provider Details

I. General information

NPI: 1992972723
Provider Name (Legal Business Name): NORTHWOOD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25790 COMMERCE DR
MADISON HEIGHTS MI
48071-4157
US

IV. Provider business mailing address

25790 COMMERCE DR
MADISON HEIGHTS MI
48071-4157
US

V. Phone/Fax

Practice location:
  • Phone: 586-755-3830
  • Fax:
Mailing address:
  • Phone: 586-755-3830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH FASSE
Title or Position: PRESIDENT
Credential:
Phone: 586-755-3830