Provider Demographics
NPI:1407570963
Name:GARUDA HEALTH LLC
Entity Type:Organization
Organization Name:GARUDA HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:D
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RMA
Authorized Official - Phone:586-354-1571
Mailing Address - Street 1:1130 CATALPA DR
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-2095
Mailing Address - Country:US
Mailing Address - Phone:248-951-8897
Mailing Address - Fax:248-591-4956
Practice Address - Street 1:1130 CATALPA DR
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-2095
Practice Address - Country:US
Practice Address - Phone:248-951-8897
Practice Address - Fax:248-591-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty