MEDICARE: MISSION POINT OF ELMWOOD 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1629676085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION POINT OF ELMWOOD LLC

Provider Business Mailing Address
First Line	:	1881 E GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-3041
Country	:	US
Telephone Number	:	313-922-1600
Fax Number	:	313-921-8380

Provider Business Practice Location Address
First Line	:	1881 E GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-3041
Country	:	US
Telephone Number	:	313-922-1600
Fax Number	:

Authorized Official
Title or Position	:	REGULATORY ANALYST
Name	:	MRS. KRISTINE RANEL KIRK
Credential	:
Telephone Number	:	417-846-3521

Provider Enumeration Date	:	10/16/2020
Last Update Date	:	07/01/2025

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Directions to “MISSION POINT OF ELMWOOD LLC ” Practice Location

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