MEDICARE: 8TH PALACE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1154015584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	8TH PALACE LLC

Provider Business Mailing Address
First Line	:	20225 ANN ARBOR TRL
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2690
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20225 ANN ARBOR TRL
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2690
Country	:	US
Telephone Number	:	248-982-6722
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FAISAL ALSAEDI
Credential	:
Telephone Number	:	248-982-6722

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	06/15/2023

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Directions to “8TH PALACE LLC ” Practice Location

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