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Organization
EAST GRAND NURSING HOME, INC.
Active
Organization
EAST GRAND NURSING HOME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN L BARTON (SECRETARY/TREASURER)
(313) 824-8224
Entity
Organization
Contact information
Practice address
130 E GRAND BLVD, DETROIT, MI 48207-3799
(313) 824-8224
(313) 824-8220
Mailing address
130 E GRAND BLVD, DETROIT, MI 48207-3799
(313) 824-8224
(313) 824-8220
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
834330
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2155219
—
MI
01
—
23E075
PROVIDER/SUPPLIER/CLIA ID
MI
05
—
60
—
MI
01
—
834330
MDCIS/BHS LICENSE NUMBER
MI
Enumeration date
01/03/2006
Last updated
08/22/2020
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