Provider Demographics
NPI:1144226713
Name:PRESBYTERIAN VILLAGE EAST
Entity Type:Organization
Organization Name:PRESBYTERIAN VILLAGE EAST
Other - Org Name:THE VILLAGE OF EAST HARBOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:PIKE
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:586-716-7411
Mailing Address - Street 1:33875 KIELY DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-3604
Mailing Address - Country:US
Mailing Address - Phone:586-716-7411
Mailing Address - Fax:586-716-7400
Practice Address - Street 1:33875 KIELY DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-3604
Practice Address - Country:US
Practice Address - Phone:586-716-7411
Practice Address - Fax:586-716-7400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESBYTERIAN VILLAGE OF MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-28
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI504012314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2897816Medicaid
MI235528Medicare Oscar/Certification