Healthcare Provider Details

I. General information

NPI: 1134222318
Provider Name (Legal Business Name): FAIR ACRES NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22600 W MAIN ST
ARMADA MI
48005-3237
US

IV. Provider business mailing address

22600 W MAIN ST
ARMADA MI
48005-3237
US

V. Phone/Fax

Practice location:
  • Phone: 586-784-5322
  • Fax: 586-784-8779
Mailing address:
  • Phone: 586-784-5322
  • Fax: 586-784-8779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number50-4060
License Number StateMI

VIII. Authorized Official

Name: MR. JEFFREY E. PRIES
Title or Position: ADMINISTRATOR
Credential:
Phone: 586-784-5322