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NPI Code Detail

MEDICARE: OPTALIS TROY OPCO LLC

MEDICARE: OPTALIS TROY OPCO 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1962108548
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPTALIS TROY OPCO LLC
Provider Business Mailing Address
First Line : 925 W SOUTH BLVD
Second Line :
City : TROY
State : MI
Zip : 48085-1502
Country : US
Telephone Number : 248-729-4400
Fax Number : 248-879-8352
Provider Business Practice Location Address
First Line : 925 W SOUTH BLVD
Second Line :
City : TROY
State : MI
Zip : 48085-1502
Country : US
Telephone Number : 248-729-4000
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : ANIKA CALHOUN
Credential :
Telephone Number : 248-729-4400
Provider Enumeration Date : 02/06/2023
Last Update Date : 06/19/2026

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