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General NPI Number Information
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NPI Number | 1699397158
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Entity Type | Organization
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Legal Business Name | AGING IN MY PLACE MOBILITY SERVICES LLC
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 05/07/2020
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Provider Practice Location Address
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Address Line | 3819 CLINTONVILLE ROAD
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City | WATERFORD
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State | MI
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Zip | 48329-2418
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Country | US
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Telephone | 248-496-6159
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Fax | 248-934-0741
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Provider Business Mailing Address
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Address Line | 5036 DIXIE HIGHWAY SUITE 300253
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City | WATERFORD
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State | MI
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Zip | 48330
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Country | US
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Telephone | 248-496-6159
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Fax | 248-934-0741
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Authorized Official
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Title or Position | MEMBER
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Name | LISE WALLACE
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Credential |
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Telephone | 248-496-6159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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