Provider Demographics
NPI:1033290960
Name:MOBIL VISITING PROFESSIONAL, INC.
Entity Type:Organization
Organization Name:MOBIL VISITING PROFESSIONAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-799-0870
Mailing Address - Street 1:21415 CIVIC CENTER DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3909
Mailing Address - Country:US
Mailing Address - Phone:248-799-0870
Mailing Address - Fax:248-799-0871
Practice Address - Street 1:21415 CIVIC CENTER DR
Practice Address - Street 2:SUITE 212
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3909
Practice Address - Country:US
Practice Address - Phone:248-799-0870
Practice Address - Fax:248-799-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPENDING251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health