Provider Demographics
NPI:1063105567
Name:ARCHES MBT LLC
Entity type:Organization
Organization Name:ARCHES MBT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-882-4030
Mailing Address - Street 1:4936 CHAMPLAIN CIR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3527
Mailing Address - Country:US
Mailing Address - Phone:248-882-4030
Mailing Address - Fax:
Practice Address - Street 1:4905 MELTON RD
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-2873
Practice Address - Country:US
Practice Address - Phone:219-938-0124
Practice Address - Fax:219-939-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility