Basic Information
| Provider Information | |||||||||
| NPI: | 1194254342 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE BAY AT WOODWARD HEALTH AND REHABILITATION CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 N VILLAGE AVE STE 126 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115703763 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9146 WOODWARD AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482021612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138751263 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2017 | ||||||||
| LastUpdateDate: | 03/26/2018 | ||||||||
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| AuthorizedOfficialLastName: | RUVEL | ||||||||
| AuthorizedOfficialFirstName: | MENACHEM | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5166059800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.