| Mindkraft Solutions Llc | |
|
17330 Northland Park Ct Southfield MI 48075-4318 | |
| (586) 925-8710 | |
| Not Available |
| Full Name | Mindkraft Solutions Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 17330 Northland Park Ct, Southfield, Michigan |
| Authorized Official Name and Position | Carlton Cain (CEO) |
| Authorized Official Contact | 5869258710 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindkraft Solutions Llc 24215 Palfrey Dr Macomb MI 48042-4724 Ph: () - | Mindkraft Solutions Llc 17330 Northland Park Ct Southfield MI 48075-4318 Ph: (586) 925-8710 |
| NPI Number | 1467207431 |
|---|---|
| Provider Enumeration Date | 04/22/2024 |
| Last Update Date | 04/22/2024 |
| Certification Date | 04/22/2024 |
| Medicare PECOS PAC ID | 0840733507 |
|---|---|
| Medicare Enrollment ID | O20240621003284 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467207431 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Sylvia M Lloyd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376807628 PECOS PAC ID: 4486991486 Enrollment ID: I20190129003366 |
| Provider Name | Carlton Cain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518435932 PECOS PAC ID: 7113300583 Enrollment ID: I20220817002646 |
| Provider Name | Deepa Devan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245073378 PECOS PAC ID: 3476093030 Enrollment ID: I20240910001640 |
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