Basic Information
| Provider Information | |||||||||
| NPI: | 1508497918 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARMONY VILLAGE SNF, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 DAVIS ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602014419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125901055 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16588 SCHAEFER HWY # 4249 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482354249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125901055 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2020 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | ZUCKERMAN | ||||||||
| AuthorizedOfficialFirstName: | YAIR | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3125901055 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.