=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770055345
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAHSHER RELIEF CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2018
-----------------------------------------------------
Last Update Date | 12/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27177 LAHSER RD STE 200
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48034-8468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-809-9250
-----------------------------------------------------
Fax | 248-809-6896
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27177 LAHSER RD STE 200
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48034-8468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-809-9250
-----------------------------------------------------
Fax | 248-809-6896
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PILLAI SUNDARAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-809-9250
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------