=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962238360
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSEBUSH INTERFAITH RETIREMENT COMMUNITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2024
-----------------------------------------------------
Last Update Date | 09/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4210 E ROSEBUSH RD
-----------------------------------------------------
City | ROSEBUSH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48878-8751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-433-0150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25200 TELEGRAPH RD STE 400
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48033-7496
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-281-2044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHILANTHROPY OPERATIONS
-----------------------------------------------------
Name | AVNI THOMAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-281-2044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------