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NPI Code Detail

MEDICARE: SOUTH HILLS, LLC

MEDICARE: SOUTH HILLS, LLC
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
1314000000XSkilled Nursing Facility634012MI

General Provider Information

NPI Number : 1508058363
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH HILLS, LLC
Provider Business Mailing Address
First Line : 3500 SOUTH BLVD W
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48309-3973
Country : US
Telephone Number : 248-852-7800
Fax Number : 248-852-6348
Provider Business Practice Location Address
First Line : 3500 SOUTH BLVD W
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48309-3973
Country : US
Telephone Number : 248-852-7800
Fax Number : 248-852-6348
Authorized Official
Title or Position : MANAGER
Name : KEITH J. POMEROY
Credential :
Telephone Number : 248-723-2100
Provider Enumeration Date : 08/15/2007
Last Update Date : 02/28/2008

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