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General NPI Number Information
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NPI Number | 1164772646
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Entity Type | Organization
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Legal Business Name | HERITAGE MANOR NURSING & REHAB CENTER
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 9500 GRAND RIVER AVE
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City | DETROIT
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State | MI
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Zip | 48204-2132
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Country | US
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Telephone | 313-491-7920
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Fax | 313-491-0510
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Provider Business Mailing Address
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Address Line | 30700 TELEGRAPH RD SUITE 2504
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City | BINGHAM FARMS
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State | MI
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Zip | 48025-4524
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Country | US
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Telephone | 248-593-1990
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Fax | 248-593-9120
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Authorized Official
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Title or Position | AUTHORIZED MEMBER
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Name | FAHIM UDDIN
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Credential |
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Telephone | 248-593-1990
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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 |
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License Number State | MI
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