Organization
ASC CA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS NICHOLS (AR DIRECTOR)
(586) 498-9440
Entity
Organization
Contact information
Practice address
1240 S WESTLAKE BLVD STE 205, WESTLAKE VILLAGE, CA 91361-1992
(586) 498-9440
Mailing address
27087 GRATIOT AVE, ROSEVILLE, MI 48066-2947
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
03/15/2007
Last updated
06/26/2008
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