MEDICARE: COURTYARD MANOR OF FARMINGTON HILLS

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	3104A0625X	Assisted Living Facility (Mental Illness)		MI

General Provider Information

NPI Number	:	1548442247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COURTYARD MANOR OF FARMINGTON HILLS

Provider Business Mailing Address
First Line	:	3275 MARTIN RD
Second Line	:	SUITE 127
City	:	COMMERCE TWP
State	:	MI
Zip	:	48390-1642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	29750 FARMINGTON RD
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-1922
Country	:	US
Telephone Number	:	248-539-0104
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	RONALD M PARADOWICZ
Credential	:
Telephone Number	:	248-926-2920

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	12/04/2007

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