=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134121353
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAMILTON NURSING HOME INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2005
-----------------------------------------------------
Last Update Date | 02/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 590 E GRAND BLVD
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48207-3534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-921-1580
-----------------------------------------------------
Fax | 313-921-1405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 590 E GRAND BLVD
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48207-3534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-921-1580
-----------------------------------------------------
Fax | 313-921-1405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MICHAEL FELDMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-921-1580
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 834400
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------