Provider Demographics
NPI:1689126468
Name:VERDUROUS ME, LLC
Entity Type:Organization
Organization Name:VERDUROUS ME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WELLNESS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LEESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSKNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-229-4016
Mailing Address - Street 1:49881 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-3309
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:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501008527225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty