Basic Information
| Provider Information | |||||||||
| NPI: | 1164772646 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HERITAGE MANOR NURSING & REHAB CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30700 TELEGRAPH RD | ||||||||
| Address2: | SUITE 2504 | ||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480254524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485931990 | ||||||||
| FaxNumber: | 2485939120 | ||||||||
| Practice Location | |||||||||
| Address1: | 9500 GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482042132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134917920 | ||||||||
| FaxNumber: | 3134910510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2012 | ||||||||
| LastUpdateDate: | 01/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | UDDIN | ||||||||
| AuthorizedOfficialFirstName: | FAHIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2485931990 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | MI | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.