Provider Demographics
NPI:1922393511
Name:BOMINDDY CENTER LLC
Entity Type:Organization
Organization Name:BOMINDDY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:D
Authorized Official - Last Name:VILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-231-6286
Mailing Address - Street 1:32744 FIVE MILE RD
Mailing Address - Street 2:LIVONIA
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3046
Mailing Address - Country:US
Mailing Address - Phone:800-930-0943
Mailing Address - Fax:800-970-7118
Practice Address - Street 1:32744 FIVE MILE RD
Practice Address - Street 2:LIVONIA
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3046
Practice Address - Country:US
Practice Address - Phone:800-930-0943
Practice Address - Fax:800-970-7118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010760212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty