MEDICARE: SANTANA MANUEL GREEN

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	310400000X	Assisted Living Facility		MI

General Provider Information

NPI Number	:	1598615742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANTANA MANUEL GREEN

Provider Business Mailing Address
First Line	:	35775 SUSSEX CT
Second Line	:
City	:	ROMULUS
State	:	MI
Zip	:	48174-6335
Country	:	US
Telephone Number	:	313-516-4176
Fax Number	:

Provider Business Practice Location Address
First Line	:	19506 PATTON ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-2053
Country	:	US
Telephone Number	:	313-516-4176
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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Directions to “ SANTANA MANUEL GREEN ” Practice Location

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