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General NPI Number Information
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NPI Number | 1063224988
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Entity Type | Organization
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Legal Business Name | MTB HOMES, LLC
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 6210 WALDON RD
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City | CLARKSTON
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State | MI
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Zip | 48346-2237
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Country | US
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Telephone | 989-402-8039
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Fax |
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Provider Business Mailing Address
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Address Line | 15093 OAK KNOLL CT
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-5779
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Country | US
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Telephone | 989-402-8039
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOANITA N MUTEBI
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Credential |
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Telephone | 989-402-8039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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