Healthcare Provider Details

I. General information

NPI: 1134446677
Provider Name (Legal Business Name): MAGNUM HEALTH AND REHAB OF MONROE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 N TELEGRAPH RD
MONROE MI
48162-3368
US

IV. Provider business mailing address

1215 N TELEGRAPH RD
MONROE MI
48162-3368
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-4848
  • Fax: 734-242-2007
Mailing address:
  • Phone: 734-242-4848
  • Fax: 734-242-2007

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: SUSAN STODDARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 734-242-4848