Provider Demographics
NPI:1699397158
Name:AGING IN MY PLACE MOBILITY SERVICES LLC
Entity Type:Organization
Organization Name:AGING IN MY PLACE MOBILITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LISE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-496-6159
Mailing Address - Street 1:5036 DIXIE HIGHWAY
Mailing Address - Street 2:SUITE 300253
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48330
Mailing Address - Country:US
Mailing Address - Phone:248-496-6159
Mailing Address - Fax:248-934-0741
Practice Address - Street 1:3819 CLINTONVILLE ROAD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-2418
Practice Address - Country:US
Practice Address - Phone:248-496-6159
Practice Address - Fax:248-934-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment