Provider Demographics
NPI:1043952211
Name:MEDIKI SENIOR CARE LLC
Entity Type:Organization
Organization Name:MEDIKI SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JVON
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:248-778-7070
Mailing Address - Street 1:16151 JAMES COUZENS FWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2821
Mailing Address - Country:US
Mailing Address - Phone:248-778-7070
Mailing Address - Fax:
Practice Address - Street 1:16151 JAMES COUZENS FWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2821
Practice Address - Country:US
Practice Address - Phone:248-778-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies