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General NPI Number Information
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NPI Number | 1508053661
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Entity Type | Organization
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Legal Business Name | WBH NCC #1, LLC
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 26001 JEFFERSON AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-2309
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Country | US
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Telephone | 586-771-7000
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Fax | 586-771-7179
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Provider Business Mailing Address
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Address Line | 26001 JEFFERSON AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-2309
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Country | US
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Telephone | 586-771-7000
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Fax | 586-771-7179
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Authorized Official
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Title or Position | COROPORATE CONTROLLER
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Name | SHEILA J REITERMAN
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Credential |
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Telephone | 248-220-5560
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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 | 504011
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License Number State | MI
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