Healthcare Provider Details

I. General information

NPI: 1750909503
Provider Name (Legal Business Name): AH WEST BLOOMFIELD SUBTENANT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5859 W MAPLE RD
WEST BLOOMFIELD MI
48322-2279
US

IV. Provider business mailing address

5859 W MAPLE RD
WEST BLOOMFIELD MI
48322-2279
US

V. Phone/Fax

Practice location:
  • Phone: 248-538-5283
  • Fax: 248-538-5290
Mailing address:
  • Phone: 248-538-5283
  • Fax: 248-538-5290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MALLORY MOCK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 248-538-5283