Provider Demographics
NPI:1598461170
Name:OPTALIS DEARBORN HEIGHTS OPCO LLC
Entity Type:Organization
Organization Name:OPTALIS DEARBORN HEIGHTS OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-277-5724
Mailing Address - Street 1:25500 MEADOWBROOK RD STE 230
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1882
Mailing Address - Country:US
Mailing Address - Phone:248-692-4355
Mailing Address - Fax:248-692-4356
Practice Address - Street 1:26001 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2920
Practice Address - Country:US
Practice Address - Phone:313-274-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility