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General NPI Number Information
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NPI Number | 1023922200
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Entity Type | Organization
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Legal Business Name | MINDGARDEN CENTER INC
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 29900 LORRAINE AVE STE 350
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City | WARREN
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State | MI
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Zip | 48093-5269
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Country | US
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Telephone | 586-393-1570
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Fax | 586-231-1480
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Provider Business Mailing Address
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Address Line | 29900 LORRAINE AVE STE 350
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City | WARREN
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State | MI
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Zip | 48093-5269
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Country | US
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Telephone | 586-393-1570
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Fax | 586-231-1480
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Authorized Official
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Title or Position | PRESIDENT
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Name | NATHAN KALASHO
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Credential |
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Telephone | 586-393-1570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | NULL
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