Healthcare Provider Details

I. General information

NPI: 1669349767
Provider Name (Legal Business Name): WARREN MP OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11525 E 10 MILE RD
WARREN MI
48089-3802
US

IV. Provider business mailing address

11525 E 10 MILE RD
WARREN MI
48089-3802
US

V. Phone/Fax

Practice location:
  • Phone: 586-759-0700
  • Fax: 586-759-2593
Mailing address:
  • Phone: 586-759-0700
  • Fax: 586-759-2593

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: TIFFANY M LOCKHART
Title or Position: CFO
Credential:
Phone: 330-223-8200