Healthcare Provider Details

I. General information

NPI: 1396723508
Provider Name (Legal Business Name): EVANGELICAL HOMES OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W RUSSELL ST
SALINE MI
48176-1184
US

IV. Provider business mailing address

440 W RUSSELL ST
SALINE MI
48176-1184
US

V. Phone/Fax

Practice location:
  • Phone: 734-429-9401
  • Fax: 734-429-0183
Mailing address:
  • Phone: 734-429-9401
  • Fax: 734-429-0183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number814120
License Number StateMI

VIII. Authorized Official

Name: JULIA WELLINGS
Title or Position: INTERIM CEO
Credential:
Phone: 734-295-9292