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General NPI Number Information
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NPI Number | 1831366335
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Entity Type | Organization
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Legal Business Name | WATSON MANOR, INC.
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 7175 HURON AVE
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City | LEXINGTON
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State | MI
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Zip | 48450-8314
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Country | US
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Telephone | 810-359-7774
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Fax | 810-359-5748
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Provider Business Mailing Address
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Address Line | 7175 HURON AVE
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City | LEXINGTON
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State | MI
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Zip | 48450-8314
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Country | US
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Telephone | 810-359-7774
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Fax | 810-359-5748
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Authorized Official
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Title or Position | PRESIDENT/MAINTENANCE
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Name | JOHN K WATSON
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Credential |
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Telephone | 810-359-7774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | AM760009656
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License Number State | MI
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