Healthcare Provider Details

I. General information

NPI: 1831149855
Provider Name (Legal Business Name): MARWOOD MANOR NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 BEARD ST
PORT HURON MI
48060-6562
US

IV. Provider business mailing address

1300 BEARD ST
PORT HURON MI
48060-6562
US

V. Phone/Fax

Practice location:
  • Phone: 810-982-9500
  • Fax: 810-982-5369
Mailing address:
  • Phone: 810-982-9500
  • Fax: 810-982-5369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number744010
License Number StateMI

VIII. Authorized Official

Name: MR. BRIAN OBERLY
Title or Position: ADMINISTRATOR
Credential:
Phone: 810-966-5381