Healthcare Provider Details

I. General information

NPI: 1508352121
Provider Name (Legal Business Name): DAVID LEVI JYLHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 COUNTY RD 480
NEGAUNEE MI
49866
US

IV. Provider business mailing address

225 COUNTY RD 480
NEGAUNEE MI
49866
US

V. Phone/Fax

Practice location:
  • Phone: 906-401-0030
  • Fax:
Mailing address:
  • Phone: 906-401-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAF520338326
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: