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NPI Code Detail

MEDICARE: EXTENDED CARE PHASE II

MEDICARE: EXTENDED CARE PHASE II
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1891871398
Entity Type Code : Organization
Provider Name (Legal Business Name) : EXTENDED CARE PHASE II
Provider Business Mailing Address
First Line : 20955 W 7 MILE RD
Second Line :
City : DETROIT
State : MI
Zip : 48219-1904
Country : US
Telephone Number : 313-255-3911
Fax Number :
Provider Business Practice Location Address
First Line : 20955 W 7 MILE RD
Second Line :
City : DETROIT
State : MI
Zip : 48219-1904
Country : US
Telephone Number : 313-255-3911
Fax Number :
Authorized Official
Title or Position : OWNER
Name : GLENN ENGLISH
Credential :
Telephone Number : 313-255-3911
Provider Enumeration Date : 10/27/2006
Last Update Date : 08/22/2020

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Directions to “EXTENDED CARE PHASE II ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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