MEDICARE: MOROUN NURSING HOME

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	314000000X	Skilled Nursing Facility	834650	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09558	OTHER	MI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801892229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOROUN NURSING HOME

Provider Business Mailing Address
First Line	:	8045 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-2627
Country	:	US
Telephone Number	:	313-821-3525
Fax Number	:	313-821-3544

Provider Business Practice Location Address
First Line	:	8045 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-2627
Country	:	US
Telephone Number	:	313-821-3525
Fax Number	:	313-821-3544

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MR. DAVID M. HENRY
Credential	:
Telephone Number	:	313-821-3525

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	02/06/2008

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Directions to “MOROUN NURSING HOME ” Practice Location

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