Healthcare Provider Details

I. General information

NPI: 1144819525
Provider Name (Legal Business Name): MISSION POINT OF SUPERIOR WOODS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 GEDDES RD
SUPERIOR TOWNSHIP MI
48198-9404
US

IV. Provider business mailing address

30700 TELEGRAPH RD STE 1510
BINGHAM FARMS MI
48025-5802
US

V. Phone/Fax

Practice location:
  • Phone: 734-547-7600
  • Fax:
Mailing address:
  • Phone: 248-940-5390
  • Fax: 248-792-9115

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: HARI S (ROGER) MALI
Title or Position: MANAGING MEMBER
Credential:
Phone: 248-940-5390