MEDICARE: PRIME CARE MANOR LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1972332294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME CARE MANOR LLC

Provider Business Mailing Address
First Line	:	554 SUPERIOR ST
Second Line	:
City	:	RIVER ROUGE
State	:	MI
Zip	:	48218-1148
Country	:	US
Telephone Number	:	313-720-1702
Fax Number	:

Provider Business Practice Location Address
First Line	:	554 SUPERIOR ST
Second Line	:
City	:	RIVER ROUGE
State	:	MI
Zip	:	48218-1148
Country	:	US
Telephone Number	:	313-720-1702
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/CEO
Name	:	SHEMELIA BURDETT-FOSTER
Credential	:
Telephone Number	:	313-720-1702

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	07/26/2024

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Directions to “PRIME CARE MANOR LLC ” Practice Location

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