Provider Demographics
NPI:1942863824
Name:MINDMINGLE LLC
Entity Type:Organization
Organization Name:MINDMINGLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:KAYAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-536-8434
Mailing Address - Street 1:26250 NORTHWESTERN HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3903
Mailing Address - Country:US
Mailing Address - Phone:734-536-8434
Mailing Address - Fax:947-282-8950
Practice Address - Street 1:675 E SQUARE LAKE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-3169
Practice Address - Country:US
Practice Address - Phone:734-536-8434
Practice Address - Fax:947-282-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care