=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902786973
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIIKO GROUP HOME LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2025
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3237 MONUMENT
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48108-2247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-276-1434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3237 MONUMENT
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48108-2247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-276-1434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MRS. FATIMA N HASSAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 734-276-1434
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------