Provider Demographics
NPI:1962383497
Name:198275 MI LLC
Entity type:Organization
Organization Name:198275 MI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-762-4211
Mailing Address - Street 1:8063 CHALLIS RD STE 1031
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-7446
Mailing Address - Country:US
Mailing Address - Phone:313-762-4211
Mailing Address - Fax:
Practice Address - Street 1:220 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067
Practice Address - Country:US
Practice Address - Phone:313-762-4211
Practice Address - Fax:313-762-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care