MEDICARE: LAW-DEN NURSING HOME, 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	313M00000X	Nursing Facility/Intermediate Care Facility	15840	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568429835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAW-DEN NURSING HOME, INC.

Provider Business Mailing Address
First Line	:	1640 WEBB ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48206-1350
Country	:	US
Telephone Number	:	313-867-1719
Fax Number	:	313-867-1840

Provider Business Practice Location Address
First Line	:	1640 WEBB ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48206-1350
Country	:	US
Telephone Number	:	313-867-1719
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. TODD JOHNSON
Credential	:
Telephone Number	:	313-867-1719

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	08/22/2020

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