NPI 1063712586 · live from the CMS NPI Registry
Boulevard Manor L.L.C.
Skilled Nursing Facility in Detroit, MI. National Provider Identifier 1063712586, active.
NPI record
| NPI | 1063712586 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Skilled Nursing Facility 314000000X |
| Practice location | 464 E Grand Blvd, Detroit, MI 48207 |
| Practice phone | 313-579-2255 |
| Mailing address | 2920 Oakwood Blvd, Suite B, Melvindale, MI 48122 |
| Enumerated | November 1, 2010 |
| Last updated | April 20, 2011 |
| Authorized official | Fahim Uddin, Authorized Member |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Skilled Nursing Facility primary | 314000000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.