Provider Demographics
NPI:1811538903
Name:LIVONIA SNF OPERATING, LLC
Entity Type:Organization
Organization Name:LIVONIA SNF OPERATING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:H
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:MALI
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:248-577-2632
Mailing Address - Street 1:721 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2867
Mailing Address - Country:US
Mailing Address - Phone:248-577-2632
Mailing Address - Fax:248-577-2648
Practice Address - Street 1:34350 ANN ARBOR TRL
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3606
Practice Address - Country:US
Practice Address - Phone:734-261-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility