Basic Information
Provider Information
NPI: 1174572408
EntityType: 2
ReplacementNPI:  
OrganizationName: RHEMA BATTLE CREEK OPERATING LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: MANOR OF BATTLE CREEK SKILLED NURSING AND REHABILITATION
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 17515 W NINE MILE RD
Address2: SUITE 925
City: SOUTHFIELD
State: MI
PostalCode: 48075
CountryCode: US
TelephoneNumber: 2485698400
FaxNumber: 2485695070
Practice Location
Address1: 675 WAGNER DR
Address2:  
City: BATTLE CREEK
State: MI
PostalCode: 49017
CountryCode: US
TelephoneNumber: 2699696244
FaxNumber: 2699624605
Other Information
ProviderEnumerationDate: 05/05/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HACK
AuthorizedOfficialFirstName: SHANNON
AuthorizedOfficialMiddleName: M
AuthorizedOfficialTitleorPosition: CFO
AuthorizedOfficialTelephone: 2485698400
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X134140MIY Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

No ID Information.


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