Healthcare Provider Details

I. General information

NPI: 1508247719
Provider Name (Legal Business Name): RHEMA REDFORD OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 06/12/2015
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

17515 W 9 MILE RD SUITE 925
SOUTHFIELD MI
48075-4403
US

V. Phone/Fax

Practice location:
  • Phone: 313-531-6874
  • Fax:
Mailing address:
  • Phone: 248-569-8400
  • Fax: 248-569-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number82-425
License Number StateMI

VIII. Authorized Official

Name: KELSEY HASTINGS
Title or Position: CEO
Credential:
Phone: 248-569-8400