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General NPI Number Information
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NPI Number | 1568258002
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Entity Type | Organization
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Legal Business Name | OPTALIS WYOMING OPCO, LLC
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 625 36TH ST SW
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City | WYOMING
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State | MI
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Zip | 49509-4004
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Country | US
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Telephone | 616-975-2180
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Fax | 616-531-0407
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Provider Business Mailing Address
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Address Line | 625 36TH ST SW
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City | WYOMING
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State | MI
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Zip | 49509-4004
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Country | US
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Telephone | 616-975-2180
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Fax | 616-531-0407
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Authorized Official
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Title or Position | CEO
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Name | RAJ PATEL
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Credential |
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Telephone | 248-692-4355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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