Provider Demographics
NPI:1881695617
Name:CHERRYWOOD NURSING & LIVING CENTER
Entity type:Organization
Organization Name:CHERRYWOOD NURSING & LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:REITERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:248-644-5522
Mailing Address - Street 1:34643 KETSIN DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5235
Mailing Address - Country:US
Mailing Address - Phone:586-978-2280
Mailing Address - Fax:586-978-8407
Practice Address - Street 1:34643 KETSIN DR
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5235
Practice Address - Country:US
Practice Address - Phone:586-978-2280
Practice Address - Fax:586-978-8407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI50406314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI09737OtherBLUE CROSS & BLUE SHIELD
MI1987202Medicaid
235484Medicare Oscar/Certification