Basic Information
| Provider Information | |||||||||
| NPI: | 1417354200 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RHEMA-ROSEVILLE OPERATING LLC | ||||||||
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| OtherOrganizationName: | ADVANTAGE LIVING CENTER-ROSEVILLE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17515 W 9 MILE RD | ||||||||
| Address2: | SUITE 925 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480754403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485698400 | ||||||||
| FaxNumber: | 2485695070 | ||||||||
| Practice Location | |||||||||
| Address1: | 25375 KELLY RD | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480664960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867736022 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2014 | ||||||||
| LastUpdateDate: | 11/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | HASTINGS | ||||||||
| AuthorizedOfficialFirstName: | KELSEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2485698400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 50418 | MI | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.