Provider Demographics
NPI:1508053661
Name:WBH NCC #1, LLC
Entity Type:Organization
Organization Name:WBH NCC #1, LLC
Other - Org Name:SHOREPOINTE NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COROPORATE CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:J
Authorized Official - Last Name:REITERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-220-5560
Mailing Address - Street 1:26001 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2309
Mailing Address - Country:US
Mailing Address - Phone:586-771-7000
Mailing Address - Fax:586-771-7179
Practice Address - Street 1:26001 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2309
Practice Address - Country:US
Practice Address - Phone:586-771-7000
Practice Address - Fax:586-771-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI504011314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI235443Medicare Oscar/Certification