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NPI Code Detail

MEDICARE: HERITAGE MANOR NURSING & REHAB CENTER

MEDICARE: HERITAGE MANOR NURSING & REHAB CENTER
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
1314000000XSkilled Nursing FacilityMI

General Provider Information

NPI Number : 1164772646
Entity Type Code : Organization
Provider Name (Legal Business Name) : HERITAGE MANOR NURSING & REHAB CENTER
Provider Business Mailing Address
First Line : 30700 TELEGRAPH RD
Second Line : SUITE 2504
City : BINGHAM FARMS
State : MI
Zip : 48025-4524
Country : US
Telephone Number : 248-593-1990
Fax Number : 248-593-9120
Provider Business Practice Location Address
First Line : 9500 GRAND RIVER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48204-2132
Country : US
Telephone Number : 313-491-7920
Fax Number : 313-491-0510
Authorized Official
Title or Position : AUTHORIZED MEMBER
Name : FAHIM UDDIN
Credential :
Telephone Number : 248-593-1990
Provider Enumeration Date : 09/12/2012
Last Update Date : 01/17/2013

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Directions to “HERITAGE MANOR NURSING & REHAB CENTER ” Practice Location

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