Organization
WEST VILLAGE SIL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA RENEE WEST (PRESIDENT)
(313) 258-6325
Entity
Organization
Contact information
Practice address
12052 MENDOTA ST, DETROIT, MI 48204
(313) 258-6325
Mailing address
12060 MENDOTA ST, DETROIT, MI 48204-1826
(313) 258-6325
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Enumeration date
08/25/2023
Last updated
08/25/2023
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