Provider Demographics
NPI:1417546888
Name:MISSION POINT OF MADISON HEIGHTS
Entity Type:Organization
Organization Name:MISSION POINT OF MADISON HEIGHTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HARI
Authorized Official - Middle Name:S (ROGER)
Authorized Official - Last Name:MALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-940-5390
Mailing Address - Street 1:30700 TELEGRAPH RD STE 1510
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5802
Mailing Address - Country:US
Mailing Address - Phone:248-940-0539
Mailing Address - Fax:248-792-9115
Practice Address - Street 1:31155 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1566
Practice Address - Country:US
Practice Address - Phone:248-585-7010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility