Basic Information
| Provider Information | |||||||||
| NPI: | 1558310888 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RHEMA WTLC OPERATING LLC | ||||||||
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| OtherOrganizationName: | MANOR OF WAYNE CONTINUING CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| 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: | 4427 VENOY RD | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347294436 | ||||||||
| FaxNumber: | 7347298410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HACK | ||||||||
| AuthorizedOfficialFirstName: | SHANNON | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2485698400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 824450 | MI | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.