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NPI Code Detail

MEDICARE: DETROIT NURSING CENTER, LLC

MEDICARE: DETROIT NURSING CENTER, LLC
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 Facility82-4012MI

Other Identifiers

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

General Provider Information

NPI Number : 1225029465
Entity Type Code : Organization
Provider Name (Legal Business Name) : DETROIT NURSING CENTER, LLC
Provider Business Mailing Address
First Line : 3701 W LUNT AVE
Second Line :
City : LINCOLNWOOD
State : IL
Zip : 60712-2615
Country : US
Telephone Number : 847-440-2660
Fax Number :
Provider Business Practice Location Address
First Line : 26505 POWERS AVE
Second Line :
City : DEARBORN HEIGHTS
State : MI
Zip : 48125-1327
Country : US
Telephone Number : 313-291-6200
Fax Number :
Authorized Official
Title or Position : CFO
Name : MARCELLA GRAF
Credential :
Telephone Number : 224-470-2044
Provider Enumeration Date : 11/04/2005
Last Update Date : 11/04/2025

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