Provider Demographics
NPI:1225030414
Name:CASS STREET INVESTORS, LLC
Entity Type:Organization
Organization Name:CASS STREET INVESTORS, LLC
Other - Org Name:WILMAR CONVALESCENT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-539-8200
Mailing Address - Street 1:7700 MCCLELLAN ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5277
Mailing Address - Country:US
Mailing Address - Phone:586-739-7700
Mailing Address - Fax:586-739-8067
Practice Address - Street 1:7700 MCCLELLAN ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5277
Practice Address - Country:US
Practice Address - Phone:586-739-7700
Practice Address - Fax:586-739-8067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI50-4130314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI235617Medicare Oscar/Certification