# BOULEVARD MANOR L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063712586
- **Authorized official:** FAHIM UDDIN (AUTHORIZED MEMBER)
- **Authorized official phone:** (313) 579-2255

## Contact information

- **Practice address:** 464 E GRAND BLVD, DETROIT, MI 48207-3637
- **Practice address phone:** (313) 579-2255
- **Practice address fax:** (313) 579-5756
- **Mailing address:** 2920 OAKWOOD BLVD, SUITE B, MELVINDALE, MI 48122-1244
- **Mailing address phone:** (313) 579-2255
- **Mailing address fax:** (313) 579-5756

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 11/01/2010
- **Last updated:** 04/20/2011