Healthcare Provider Details

I. General information

NPI: 1093067613
Provider Name (Legal Business Name): THE VILLAGE OF REDFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25330 W 6 MILE RD
REDFORD MI
48240-2105
US

IV. Provider business mailing address

25330 W 6 MILE RD
REDFORD MI
48240-2105
US

V. Phone/Fax

Practice location:
  • Phone: 313-541-6063
  • Fax: 313-541-6491
Mailing address:
  • Phone: 313-541-6063
  • Fax: 313-541-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number82 4250
License Number StateMI

VIII. Authorized Official

Name: MRS. DEBRA CURRIER
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 313-541-6063