Healthcare Provider Details

I. General information

NPI: 1386183671
Provider Name (Legal Business Name): RHEMA WARREN OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 E 12 MILE RD
WARREN MI
48093-3516
US

IV. Provider business mailing address

25800 NORTHWESTERN HWY SUITE 720
SOUTHFIELD MI
48075-8403
US

V. Phone/Fax

Practice location:
  • Phone: 586-751-6200
  • Fax:
Mailing address:
  • Phone: 248-569-8400
  • Fax: 248-569-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number50401
License Number StateMI

VIII. Authorized Official

Name: KELSEY HASTINGS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 248-569-8400