Healthcare Provider Details

I. General information

NPI: 1336466929
Provider Name (Legal Business Name): MAGNUM HEALTH AND REHAB OF ADRIAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2010
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 SAND CREEK HWY
ADRIAN MI
49221-9129
US

IV. Provider business mailing address

130 SAND CREEK HWY
ADRIAN MI
49221-9129
US

V. Phone/Fax

Practice location:
  • Phone: 517-265-6554
  • Fax: 517-263-0657
Mailing address:
  • Phone: 517-265-6554
  • Fax: 517-263-0657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: VIOLA DAVIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 517-265-6554