Healthcare Provider Details

I. General information

NPI: 1245211408
Provider Name (Legal Business Name): FRIENDSHIP MANOR NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 BEAUBIEN ST
DETROIT MI
48201-2120
US

IV. Provider business mailing address

3950 BEAUBIEN ST
DETROIT MI
48201-2120
US

V. Phone/Fax

Practice location:
  • Phone: 313-833-7600
  • Fax: 313-833-0366
Mailing address:
  • Phone: 313-833-7600
  • Fax: 313-833-0366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number83-4370
License Number StateMI

VIII. Authorized Official

Name: MRS. JANET S EDWARDS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 313-833-7600