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General NPI Number Information
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NPI Number | 1003240268
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Entity Type | Organization
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Legal Business Name | MICHIGAN HEALTH SOURCE FACILITIES LLC
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Dates
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Enumeration Date | 08/23/2013
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Last Update Date | 08/23/2013
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Provider Practice Location Address
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Address Line | 28075 JOHN R RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-2809
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Country | US
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Telephone | 248-548-3445
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 71162
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-0022
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Country | US
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Telephone | 248-894-8248
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Fax | 888-338-9319
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. TANYA LITTLE
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Credential |
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Telephone | 248-894-8248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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