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NPI Code Detail

MEDICARE: SELECT SPECIALTY HOSPITAL - NORTHWEST DETROIT INC

MEDICARE: SELECT SPECIALTY HOSPITAL - NORTHWEST DETROIT INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1282E00000XLong Term Care Hospital830523MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
109325OTHERMIBCBS MI

General Provider Information

NPI Number : 1205836806
Entity Type Code : Organization
Provider Name (Legal Business Name) : SELECT SPECIALTY HOSPITAL - NORTHWEST DETROIT INC
Provider Business Mailing Address
First Line : 4714 GETTYSBURG RD
Second Line : LEGAL DEPT.
City : MECHANICSBURG
State : PA
Zip : 17055-4325
Country : US
Telephone Number : 717-972-1100
Fax Number : 717-975-9981
Provider Business Practice Location Address
First Line : 6071 W OUTER DR
Second Line : 7TH FLOOR
City : DETROIT
State : MI
Zip : 48235-2624
Country : US
Telephone Number : 313-966-4797
Fax Number : 313-966-6137
Authorized Official
Title or Position : VICE PRESIDENT
Name : MR. MICHAEL E. TARVIN
Credential :
Telephone Number : 717-972-1100
Provider Enumeration Date : 07/26/2005
Last Update Date : 09/02/2010

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Directions to “SELECT SPECIALTY HOSPITAL - NORTHWEST DETROIT INC ” Practice Location

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