Basic Information
| Provider Information | |||||||||
| NPI: | 1528015625 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TROUSDALE FOUNDATION OF MICHIGAN, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MARION MANOR NURSING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 485 CENTRAL AVE NE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373115541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234785953 | ||||||||
| FaxNumber: | 4234790476 | ||||||||
| Practice Location | |||||||||
| Address1: | 18591 QUARRY ST | ||||||||
| Address2: | |||||||||
| City: | RIVERVIEW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481934522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342822100 | ||||||||
| FaxNumber: | 7342822136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4234785953 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 824210 | MI | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.