MEDICARE: ST. MICHAEL NURSING CENTER

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	834031	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	:	1952397226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MICHAEL NURSING CENTER

Provider Business Mailing Address
First Line	:	19175 ANGLIN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-1407
Country	:	US
Telephone Number	:	313-892-3600
Fax Number	:	313-892-5624

Provider Business Practice Location Address
First Line	:	19175 ANGLIN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-1407
Country	:	US
Telephone Number	:	313-892-3600
Fax Number	:	313-892-5624

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. PAMELA A JOHNSON
Credential	:
Telephone Number	:	313-892-3600

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	08/22/2020

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