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General NPI Number Information
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NPI Number | 1538409685
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Entity Type | Organization
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Legal Business Name | GOOD FAITH MANOR LLC
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Dates
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Enumeration Date | 02/27/2013
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 18759 GREENWALD DR
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5868
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Country | US
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Telephone | 248-632-3778
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Fax |
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Provider Business Mailing Address
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Address Line | 18759 GREENWALD DR
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5868
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Country | US
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Telephone | 248-632-3778
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE & FREDRICK HAYES
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Credential |
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Telephone | 248-632-3778
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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 | AF630313888
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License Number State | MI
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