Healthcare Provider Details

I. General information

NPI: 1831366335
Provider Name (Legal Business Name): WATSON MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7175 HURON AVE
LEXINGTON MI
48450-8314
US

IV. Provider business mailing address

7175 HURON AVE
LEXINGTON MI
48450-8314
US

V. Phone/Fax

Practice location:
  • Phone: 810-359-7774
  • Fax: 810-359-5748
Mailing address:
  • Phone: 810-359-7774
  • Fax: 810-359-5748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAM760009656
License Number StateMI

VIII. Authorized Official

Name: JOHN K WATSON
Title or Position: PRESIDENT/MAINTENANCE
Credential:
Phone: 810-359-7774