Provider Demographics
NPI:1689672107
Name:GENEVA MANAGEMENT
Entity Type:Organization
Organization Name:GENEVA MANAGEMENT
Other - Org Name:BOULEVARD HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/AMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:248-852-7800
Mailing Address - Street 1:3500 SOUTH BLVD W
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3973
Mailing Address - Country:US
Mailing Address - Phone:248-852-7800
Mailing Address - Fax:248-852-6348
Practice Address - Street 1:3500 SOUTH BLVD W
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3973
Practice Address - Country:US
Practice Address - Phone:248-852-7800
Practice Address - Fax:248-852-6348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI634012313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4506126Medicaid
MI4506126Medicaid