Provider Demographics
NPI:1144542176
Name:BG II LLC
Entity type:Organization
Organization Name:BG II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:INNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-562-7056
Mailing Address - Street 1:5163 N. KELLEN COURT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48302
Mailing Address - Country:US
Mailing Address - Phone:248-562-7056
Mailing Address - Fax:
Practice Address - Street 1:2109 GOLFVIEW DR APT 101
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3926
Practice Address - Country:US
Practice Address - Phone:248-562-7056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health