Healthcare Provider Details

I. General information

NPI: 1932958378
Provider Name (Legal Business Name): OPTALIS SAGINAW OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N RIVER RD
SAGINAW MI
48609-6831
US

IV. Provider business mailing address

25500 MEADOWBROOK RD STE 230
NOVI MI
48375-1882
US

V. Phone/Fax

Practice location:
  • Phone: 989-781-3150
  • Fax:
Mailing address:
  • Phone: 248-692-4355
  • Fax: 248-692-4356

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: RAJAN PATEL
Title or Position: CEO
Credential:
Phone: 248-692-4355