Provider Demographics
NPI:1174222590
Name:LEVINE, YISROEL (LNHA)
Entity type:Individual
Prefix:
First Name:YISROEL
Middle Name:
Last Name:LEVINE
Suffix:
Gender:M
Credentials:LNHA
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:24361 GREENFIELD RD STE 208I
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3165
Mailing Address - Country:US
Mailing Address - Phone:248-635-4650
Mailing Address - Fax:
Practice Address - Street 1:675 WAGNER DR
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-5721
Practice Address - Country:US
Practice Address - Phone:269-969-6244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility