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NPI Code Detail

MEDICARE: MONTCLAIR SPECIALIZED RESIDENTIAL

MEDICARE: MONTCLAIR SPECIALIZED RESIDENTIAL
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
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1629752241
Entity Type Code : Organization
Provider Name (Legal Business Name) : MONTCLAIR SPECIALIZED RESIDENTIAL
Provider Business Mailing Address
First Line : PO BOX 190024
Second Line :
City : BURTON
State : MI
Zip : 48519-0024
Country : US
Telephone Number : 480-709-6403
Fax Number :
Provider Business Practice Location Address
First Line : 2101 MONTCLAIR AVE
Second Line :
City : FLINT
State : MI
Zip : 48503-2220
Country : US
Telephone Number : 833-478-9464
Fax Number :
Authorized Official
Title or Position : OWNER/OPERATOR
Name : SPENCER BERTRAM JR.
Credential :
Telephone Number : 480-709-6403
Provider Enumeration Date : 06/14/2023
Last Update Date : 06/14/2023

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Directions to “MONTCLAIR SPECIALIZED RESIDENTIAL ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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