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General NPI Number Information
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NPI Number | 1114974391
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Entity Type | Organization
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Legal Business Name | FENTON HEALTHCARE LLC
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 01/15/2016
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Provider Practice Location Address
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Address Line | 512 BEACH ST
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City | FENTON
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State | MI
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Zip | 48430-3122
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Country | US
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Telephone | 810-629-4117
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Fax | 810-629-0491
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Provider Business Mailing Address
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Address Line | 512 BEACH ST
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City | FENTON
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State | MI
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Zip | 48430-3122
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Country | US
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Telephone | 810-629-4117
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Fax | 810-629-0491
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Authorized Official
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Title or Position | MANAGER
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Name | LARRY D. WHITE
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Credential |
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Telephone | 810-629-4117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 254050
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License Number State | MI
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