Provider Demographics
NPI:1508964255
Name:DEAN'S MANOR INC.
Entity Type:Organization
Organization Name:DEAN'S MANOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENA
Authorized Official - Middle Name:DESHONE
Authorized Official - Last Name:JORDAN-ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-388-9648
Mailing Address - Street 1:22745 JEFFERSON
Mailing Address - Street 2:
Mailing Address - City:ST.CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080
Mailing Address - Country:US
Mailing Address - Phone:313-388-9648
Mailing Address - Fax:313-388-4013
Practice Address - Street 1:4328 7TH STREET
Practice Address - Street 2:4329 7TH STREET
Practice Address - City:ECORSE
Practice Address - State:MI
Practice Address - Zip Code:48229
Practice Address - Country:US
Practice Address - Phone:313-388-9648
Practice Address - Fax:313-388-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities