Healthcare Provider Details

I. General information

NPI: 1700757440
Provider Name (Legal Business Name): KOBY EMPIRE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4322 BUCKINGHAM RD
ROYAL OAK MI
48073-6220
US

IV. Provider business mailing address

4322 BUCKINGHAM RD
ROYAL OAK MI
48073-6220
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-4536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KOBY CONRAD
Title or Position: PRESIDENT
Credential:
Phone: 313-751-0022