Healthcare Provider Details

I. General information

NPI: 1750177291
Provider Name (Legal Business Name): OPTALIS WHITEHALL OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 E LEWIS ST
WHITEHALL MI
49461-1699
US

IV. Provider business mailing address

916 E LEWIS ST
WHITEHALL MI
49461-1699
US

V. Phone/Fax

Practice location:
  • Phone: 231-894-4056
  • Fax: 231-893-1106
Mailing address:
  • Phone: 231-894-4056
  • Fax: 231-893-1106

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: RAJ PATEL
Title or Position: CEO
Credential:
Phone: 248-692-4355