Provider Demographics
NPI:1326702606
Name:DRAKE WOOD MANOR
Entity Type:Organization
Organization Name:DRAKE WOOD MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BHATTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-797-8519
Mailing Address - Street 1:19387 ISABELLA DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5422
Mailing Address - Country:US
Mailing Address - Phone:248-674-2658
Mailing Address - Fax:248-674-1919
Practice Address - Street 1:4353 W WALTON BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4071
Practice Address - Country:US
Practice Address - Phone:248-674-2658
Practice Address - Fax:248-674-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility