MEDICARE: HAMILTON NURSING HOME INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	834400	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134121353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAMILTON NURSING HOME INC.

Provider Business Mailing Address
First Line	:	590 E GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-3534
Country	:	US
Telephone Number	:	313-921-1580
Fax Number	:	313-921-1405

Provider Business Practice Location Address
First Line	:	590 E GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-3534
Country	:	US
Telephone Number	:	313-921-1580
Fax Number	:	313-921-1405

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHAEL FELDMAN
Credential	:
Telephone Number	:	313-921-1580

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	02/10/2012

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