Healthcare Provider Details

I. General information

NPI: 1881695617
Provider Name (Legal Business Name): CHERRYWOOD NURSING & LIVING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34643 KETSIN DR
STERLING HTS MI
48310-5235
US

IV. Provider business mailing address

34643 KETSIN DR
STERLING HTS MI
48310-5235
US

V. Phone/Fax

Practice location:
  • Phone: 586-978-2280
  • Fax: 586-978-8407
Mailing address:
  • Phone: 586-978-2280
  • Fax: 586-978-8407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number50406
License Number StateMI

VIII. Authorized Official

Name: MRS. SHEILA REITERMAN
Title or Position: CORPORATE CONTROLLER
Credential: NHA
Phone: 248-644-5522