Provider Demographics
NPI:1285267831
Name:MISSION POINT OF GREENVILLE, LLC
Entity type:Organization
Organization Name:MISSION POINT OF GREENVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HARI
Authorized Official - Middle Name:S (ROGER)
Authorized Official - Last Name:MALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-577-2632
Mailing Address - Street 1:4630 PLAINFIELD AVE NE STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1643
Mailing Address - Country:US
Mailing Address - Phone:248-577-2632
Mailing Address - Fax:248-577-2648
Practice Address - Street 1:828 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2056
Practice Address - Country:US
Practice Address - Phone:248-577-2632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility