Healthcare Provider Details

I. General information

NPI: 1104222520
Provider Name (Legal Business Name): WELLBRIDGE OF FENTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PINE CREEK DRIVE
FENTON MI
48430
US

IV. Provider business mailing address

901 PINE CREEK DRIVE
FENTON MI
48430
US

V. Phone/Fax

Practice location:
  • Phone: 810-623-5216
  • Fax: 517-947-4450
Mailing address:
  • Phone: 810-623-5216
  • Fax: 517-947-4450

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: MR. MICHAEL DANIEL PERRY
Title or Position: COO
Credential: NHA
Phone: 810-623-5216