1053575118 NPI number — NORTH MACOMB MRT CENTER LLC

Table of content: (NPI 1053575118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053575118 NPI number — NORTH MACOMB MRT CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH MACOMB MRT CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053575118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44000 GARFIELD ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48038-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-412-4423
Provider Business Mailing Address Fax Number:
586-412-4102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17900 23 MILE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACOMB TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-868-9060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AREF
Authorized Official First Name:
AMR
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
586-868-9060

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)