Provider Demographics
NPI:1407855695
Name:PRESBYTERIAN VILLAGE REDFORD
Entity Type:Organization
Organization Name:PRESBYTERIAN VILLAGE REDFORD
Other - Org Name:THE VILLAGE OF REDFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NHA
Authorized Official - Phone:313-541-6418
Mailing Address - Street 1:25330 W 6 MILE RD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-2105
Mailing Address - Country:US
Mailing Address - Phone:313-531-6874
Mailing Address - Fax:313-541-6491
Practice Address - Street 1:25330 W 6 MILE RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-2105
Practice Address - Country:US
Practice Address - Phone:313-531-6874
Practice Address - Fax:313-541-6491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI824250314000000X
MI310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI824250OtherSTATE FACILITY NUMBER
MI824250OtherSTATE FACILITY NUMBER