Healthcare Provider Details

I. General information

NPI: 1023922200
Provider Name (Legal Business Name): MINDGARDEN CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29900 LORRAINE AVE STE 350
WARREN MI
48093-5269
US

IV. Provider business mailing address

29900 LORRAINE AVE STE 350
WARREN MI
48093-5269
US

V. Phone/Fax

Practice location:
  • Phone: 586-393-1570
  • Fax: 586-231-1480
Mailing address:
  • Phone: 586-393-1570
  • Fax: 586-231-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: NATHAN KALASHO
Title or Position: PRESIDENT
Credential:
Phone: 586-393-1570