Healthcare Provider Details

I. General information

NPI: 1528015625
Provider Name (Legal Business Name): TROUSDALE FOUNDATION OF MICHIGAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18591 QUARRY ST
RIVERVIEW MI
48193-4522
US

IV. Provider business mailing address

485 CENTRAL AVE NE
CLEVELAND TN
37311-5541
US

V. Phone/Fax

Practice location:
  • Phone: 734-282-2100
  • Fax: 734-282-2136
Mailing address:
  • Phone: 423-478-5953
  • Fax: 423-479-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number824210
License Number StateMI

VIII. Authorized Official

Name: MR. THOMAS D JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 423-478-5953