Organization
MARIAM HOSPICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. IMMACULATA OBIOMA NWACHUKWU (OWNER)
(734) 254-0092
Entity
Organization
Contact information
Practice address
42000 KOPPERNICK RD., STE.-A-7, CANTON, MI 48187-4282
(734) 254-0092
(734) 254-0180
Mailing address
42000 KOPPERNICK RD., STE.-A-7, CANTON, MI 48187-4282
(734) 254-0092
(734) 254-0180
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D58232
STATE ID
MI
Enumeration date
05/03/2011
Last updated
05/03/2011
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