Healthcare Provider Details

I. General information

NPI: 1508058363
Provider Name (Legal Business Name): SOUTH HILLS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 SOUTH BLVD W
ROCHESTER HILLS MI
48309-3973
US

IV. Provider business mailing address

3500 SOUTH BLVD W
ROCHESTER HILLS MI
48309-3973
US

V. Phone/Fax

Practice location:
  • Phone: 248-852-7800
  • Fax: 248-852-6348
Mailing address:
  • Phone: 248-852-7800
  • Fax: 248-852-6348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number634012
License Number StateMI

VIII. Authorized Official

Name: KEITH J. POMEROY
Title or Position: MANAGER
Credential:
Phone: 248-723-2100