Healthcare Provider Details

I. General information

NPI: 1275077273
Provider Name (Legal Business Name): MEADOWS ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 NORTH AVE
MOUNT CLEMENS MI
48043-5543
US

IV. Provider business mailing address

41504 THOREAU RDG
NOVI MI
48377-2853
US

V. Phone/Fax

Practice location:
  • Phone: 586-864-5608
  • Fax:
Mailing address:
  • Phone: 586-864-5608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. VINCENT POMA
Title or Position: CEO
Credential:
Phone: 586-864-5608