Provider Demographics
NPI:1336690866
Name:FLATROCK MANOR OF BURTON INC
Entity Type:Organization
Organization Name:FLATROCK MANOR OF BURTON INC
Other - Org Name:GSM INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-964-1430
Mailing Address - Street 1:1345 CONNELL ST
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-2201
Mailing Address - Country:US
Mailing Address - Phone:810-743-7697
Mailing Address - Fax:810-743-7370
Practice Address - Street 1:1345 CONNELL ST
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-2201
Practice Address - Country:US
Practice Address - Phone:810-743-7697
Practice Address - Fax:810-743-7370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL250314581320600000X
MIAL250312953320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities