Provider Demographics
NPI:1700424710
Name:ST ELIZABETH BRIARBANK HOME FOR THE AGED
Entity Type:Organization
Organization Name:ST ELIZABETH BRIARBANK HOME FOR THE AGED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEFIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-644-1011
Mailing Address - Street 1:39315 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5024
Mailing Address - Country:US
Mailing Address - Phone:248-644-1011
Mailing Address - Fax:248-644-1596
Practice Address - Street 1:39315 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5024
Practice Address - Country:US
Practice Address - Phone:248-644-1011
Practice Address - Fax:248-644-1596
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAUGHTERS OF DIVINE CHARITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility