MEDICARE: THE WINCHESTER ASSISTED LIVING & RESPITE HOME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3104A0625X	Assisted Living Facility (Mental Illness)
2	320800000X	Mental Illness Community Based Residential Treatment Facility
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
4	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1790489920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WINCHESTER ASSISTED LIVING & RESPITE HOME LLC

Provider Business Mailing Address
First Line	:	3089 WINCHESTER RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2411
Country	:	US
Telephone Number	:	248-970-2922
Fax Number	:

Provider Business Practice Location Address
First Line	:	3089 WINCHESTER RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2411
Country	:	US
Telephone Number	:	248-970-2922
Fax Number	:

Authorized Official
Title or Position	:	LICENSEE DESIGNEE
Name	:	MR. EUGENE GILLESPIE
Credential	:
Telephone Number	:	313-820-5548

Provider Enumeration Date	:	03/30/2023
Last Update Date	:	03/30/2023

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Directions to “THE WINCHESTER ASSISTED LIVING & RESPITE HOME LLC ” Practice Location

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