Healthcare Provider Details

I. General information

NPI: 1538164843
Provider Name (Legal Business Name): METRO MAN I INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16588 SCHAEFER HWY
DETROIT MI
48235-4249
US

IV. Provider business mailing address

25440 5 MILE RD
REDFORD MI
48239-3881
US

V. Phone/Fax

Practice location:
  • Phone: 313-345-5000
  • Fax: 313-345-4036
Mailing address:
  • Phone: 313-255-2273
  • Fax: 313-255-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number83-4070
License Number StateMI

VIII. Authorized Official

Name: MR. CHARLES A DUNN
Title or Position: PRESIDENT
Credential:
Phone: 313-255-2273