Provider Demographics
NPI:1457390825
Name:WHITEHALL OF NOVI HEALTHCARE LLC
Entity Type:Organization
Organization Name:WHITEHALL OF NOVI HEALTHCARE LLC
Other - Org Name:WHITEHALL HEALTHCARE CENTER OF NOVI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BARTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-349-2200
Mailing Address - Street 1:43455 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3100
Mailing Address - Country:US
Mailing Address - Phone:248-349-2200
Mailing Address - Fax:248-349-2228
Practice Address - Street 1:43455 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3100
Practice Address - Country:US
Practice Address - Phone:248-349-2200
Practice Address - Fax:248-349-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI634430314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4645700Medicaid
235572Medicare Oscar/Certification