Provider Demographics
NPI:1275748022
Name:SENIOR COMMUNITY NURSING CENTER
Entity Type:Organization
Organization Name:SENIOR COMMUNITY NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KASLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-343-8000
Mailing Address - Street 1:18300 E WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1343
Mailing Address - Country:US
Mailing Address - Phone:313-343-8000
Mailing Address - Fax:313-343-8959
Practice Address - Street 1:18300 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1343
Practice Address - Country:US
Practice Address - Phone:313-343-8000
Practice Address - Fax:313-343-8959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-5476Medicare Oscar/Certification