Organization
LOVE KNOT MEDICAL CENTER,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KANISHA BREWER (ADMINSTRATOR)
(313) 627-1422
Entity
Organization
Contact information
Practice address
17234 GODDARD RD, ALLEN PARK, MI 48101-4100
(313) 627-1422
Mailing address
17234 GODDARD RD, ALLEN PARK, MI 48101-4100
(313) 627-1422
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
261QP3300X
Pain Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Enumeration date
12/14/2011
Last updated
12/14/2011
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