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General NPI Number Information
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NPI Number | 1033199849
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Entity Type | Organization
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Legal Business Name | ST JOHN SENIOR COMMUNITY
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18300 E WARREN
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City | DETROIT
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State | MI
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Zip | 48224
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Country | US
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Telephone | 313-343-8000
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Fax | 313-343-8959
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Provider Business Mailing Address
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Address Line | 28000 DEQUINDRE
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City | WARREN
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State | MI
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Zip | 48092
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Country | US
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Telephone | 586-753-0310
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT FINANCE
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Name | TOMASINE F MARX
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Credential |
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Telephone | 586-753-0310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | MI
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