MEDICARE: BORTZ GREENLAKE RESTHAVEN, 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
1	314000000X	Skilled Nursing Facility	634060	MI

General Provider Information

NPI Number	:	1487731881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORTZ GREENLAKE RESTHAVEN, INC

Provider Business Mailing Address
First Line	:	11700 E 10 MILE RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-3903
Country	:	US
Telephone Number	:	586-759-5966
Fax Number	:	586-759-8006

Provider Business Practice Location Address
First Line	:	6470 ALDEN DR
Second Line	:
City	:	ORCHARD LAKE
State	:	MI
Zip	:	48324-2006
Country	:	US
Telephone Number	:	248-363-4121
Fax Number	:	248-363-5657

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DONALD JAMES BORTZ
Credential	:
Telephone Number	:	586-759-5966

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

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