Redford Village Mi Wellness LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

REDFORD VILLAGE MI WELLNESS LLC

Practice address

25330 W 6 Mile Rd
Redford, MI 48240-2105

Phone

(718) 838-1501

NPI assigned

Oct 1, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rob Korn

Title

Manager

Phone

(718) 838-1501

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1417629031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "362 E KENNEDY BLVD",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087011434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25330 W 6 MILE RD",
            "city": "REDFORD",
            "state": "MI",
            "postal_code": "482402105",
            "telephone_number": "718-838-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDFORD VILLAGE MI WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-01",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "KORN",
        "authorized_official_first_name": "ROB",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "718-838-1501"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.