Provider Demographics
NPI:1962287318
Name:WEST VILLAGE SIL LLC
Entity type:Organization
Organization Name:WEST VILLAGE SIL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-258-6325
Mailing Address - Street 1:12060 MENDOTA ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48204-1826
Mailing Address - Country:US
Mailing Address - Phone:313-258-6325
Mailing Address - Fax:
Practice Address - Street 1:12052 MENDOTA ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204
Practice Address - Country:US
Practice Address - Phone:313-258-6325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization