Healthcare Provider Details

I. General information

NPI: 1013912922
Provider Name (Legal Business Name): PARK NURSING CENTER OF TAYLOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12575 TELEGRAPH RD
TAYLOR MI
48180-4019
US

IV. Provider business mailing address

3701 W LUNT AVE
LINCOLNWOOD IL
60712-2615
US

V. Phone/Fax

Practice location:
  • Phone: 734-287-4710
  • Fax:
Mailing address:
  • Phone: 847-440-2660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number824500
License Number StateMI

VIII. Authorized Official

Name: MARCELLA GRAF
Title or Position: CFO
Credential:
Phone: 224-470-2044