Provider Demographics
NPI:1073518171
Name:WEST BLOOMFIELD HEALTH AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:WEST BLOOMFIELD HEALTH AND REHABILITATION CENTER, LLC
Other - Org Name:WEST BLOOMFIELD HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-661-2088
Mailing Address - Street 1:6445 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2047
Mailing Address - Country:US
Mailing Address - Phone:248-661-1600
Mailing Address - Fax:248-661-2276
Practice Address - Street 1:6445 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2047
Practice Address - Country:US
Practice Address - Phone:248-661-1600
Practice Address - Fax:248-661-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI634019314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI09831OtherBLUE CROSS BLUE SHIELD
MI1608912Medicaid
MI235488Medicare ID - Type Unspecified