Healthcare Provider Details

I. General information

NPI: 1003732017
Provider Name (Legal Business Name): MIDWEST CONNECTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24225 W 9 MILE RD
SOUTHFIELD MI
48033-3962
US

IV. Provider business mailing address

24225 W 9 MILE RD
SOUTHFIELD MI
48033-3962
US

V. Phone/Fax

Practice location:
  • Phone: 947-281-7941
  • Fax:
Mailing address:
  • Phone: 947-281-7941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: TELRAH TANKSLEY
Title or Position: ACCOUNT SPECIALIST
Credential:
Phone: 947-281-7541