Healthcare Provider Details

I. General information

NPI: 1538798731
Provider Name (Legal Business Name): WINDEMERE PARK OF TROY OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5990 N ADAMS RD
TROY MI
48098-2377
US

IV. Provider business mailing address

30078 SCHOENHERR RD STE 300
WARREN MI
48088-3178
US

V. Phone/Fax

Practice location:
  • Phone: 248-602-2400
  • Fax: 248-602-2401
Mailing address:
  • Phone: 586-563-1500
  • Fax: 586-541-8540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: VIJAY SHENOY
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 586-981-0813