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NPI Code Detail

MEDICARE: NEW LIGHT BAPTIST CHURCH NURSING HOME, INC.

MEDICARE: NEW LIGHT BAPTIST CHURCH 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
1314000000XSkilled Nursing Facility2152057MI

Other Identifiers

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

General Provider Information

NPI Number : 1720071707
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW LIGHT BAPTIST CHURCH NURSING HOME, INC.
Provider Business Mailing Address
First Line : 9500 GRAND RIVER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48204-2132
Country : US
Telephone Number : 313-491-7920
Fax Number : 313-491-0510
Provider Business Practice Location Address
First Line : 9500 GRAND RIVER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48204-2132
Country : US
Telephone Number : 313-491-7920
Fax Number : 313-491-0510
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. GEORGE B. TALLEY
Credential :
Telephone Number : 313-491-7920
Provider Enumeration Date : 08/25/2005
Last Update Date : 08/22/2020

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Directions to “NEW LIGHT BAPTIST CHURCH NURSING HOME, INC. ” Practice Location

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