Provider Demographics
NPI:1124548185
Name:VERDUROUS ME, LLC
Entity Type:Organization
Organization Name:VERDUROUS ME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANKSNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-420-7439
Mailing Address - Street 1:25645 INGLESIDE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-4844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:49881 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-3309
Practice Address - Country:US
Practice Address - Phone:248-229-4016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
MI68663511175L00000X
MI18966MIPFT2255A2300X
MI7501010100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No175L00000XOther Service ProvidersHomeopathGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI106H00000XOtherMARRIAGE & FAMILY SPECIALIST
MI174H00000XOtherHEALTH EDUCATOR
MI133NN1002XOtherNUTRITION SPECIALIST
MI175L00000XOtherHOMEOPATH
MI2255A2300XOtherSPECIALIST ATHLETIC TRAINER