Provider Demographics
NPI:1003923947
Name:LANDERS & LANDERS HOME FOR THE AGED, INC.
Entity type:Organization
Organization Name:LANDERS & LANDERS HOME FOR THE AGED, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:AULEASE
Authorized Official - Last Name:LANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:SWT
Authorized Official - Phone:248-260-7042
Mailing Address - Street 1:PO BOX 33202
Mailing Address - Street 2:1886 HICKORY BARK LANE
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1116
Mailing Address - Country:US
Mailing Address - Phone:248-260-7042
Mailing Address - Fax:248-260-7026
Practice Address - Street 1:1886 HICKORY BARK LN
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-1116
Practice Address - Country:US
Practice Address - Phone:248-260-7042
Practice Address - Fax:248-260-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI311500000X311500000X
MI315D00000X, 311ZA0620X
315D00000X
AS630337500311ZA0620X
MIAS630337500311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003923947OtherNPI