Healthcare Provider Details

I. General information

NPI: 1851840268
Provider Name (Legal Business Name): SALEM MANOR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9422 NORTHLAWN ST
DETROIT MI
48204-2788
US

IV. Provider business mailing address

30225 SUMMIT DR APT 102
FARMINGTON HILLS MI
48334-2445
US

V. Phone/Fax

Practice location:
  • Phone: 313-505-6525
  • Fax:
Mailing address:
  • Phone: 313-505-6525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: NICOLE S WILLIAMS
Title or Position: OWNER
Credential:
Phone: 313-505-6525