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General NPI Number Information
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NPI Number | 1326702606
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Entity Type | Organization
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Legal Business Name | DRAKE WOOD MANOR
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Dates
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Enumeration Date | 10/24/2021
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Last Update Date | 10/24/2021
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Provider Practice Location Address
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Address Line | 4353 W WALTON BLVD
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City | WATERFORD
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State | MI
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Zip | 48329-4071
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Country | US
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Telephone | 248-674-2658
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Fax | 248-674-1919
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Provider Business Mailing Address
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Address Line | 19387 ISABELLA DR
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City | MACOMB
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State | MI
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Zip | 48044-5422
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Country | US
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Telephone | 248-674-2658
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Fax | 248-674-1919
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SUNIL R BHATTAD
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Credential |
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Telephone | 248-797-8519
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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 |
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