Healthcare Provider Details

I. General information

NPI: 1528476249
Provider Name (Legal Business Name): WELLBRIDGE OF NOVI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 06/12/2022
Certification Date: 06/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48300 W 11 MILE RD
NOVI MI
48374-1718
US

IV. Provider business mailing address

48300 W 11 MILE RD
NOVI MI
48374
US

V. Phone/Fax

Practice location:
  • Phone: 248-662-2300
  • Fax: 248-662-2304
Mailing address:
  • Phone: 248-662-2300
  • Fax: 248-662-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: TODD SANGSTER
Title or Position: CFO
Credential:
Phone: 810-534-0150