1699397158 NPI number — AGING IN MY PLACE MOBILITY SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699397158 NPI number — AGING IN MY PLACE MOBILITY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGING IN MY PLACE MOBILITY SERVICES 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:
1699397158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5036 DIXIE HIGHWAY
Provider Second Line Business Mailing Address:
SUITE 300253
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-496-6159
Provider Business Mailing Address Fax Number:
248-934-0741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3819 CLINTONVILLE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48329-2418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-496-6159
Provider Business Practice Location Address Fax Number:
248-934-0741
Provider Enumeration Date:
05/07/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WALLACE
Authorized Official First Name:
LISE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
248-496-6159

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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