# EAST GRAND NURSING HOME, INC.

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

## Provider details

- **NPI number:** 1184602088
- **Authorized official:** MR. JOHN L BARTON (SECRETARY/TREASURER)
- **Authorized official phone:** (313) 824-8224

## Contact information

- **Practice address:** 130 E GRAND BLVD, DETROIT, MI 48207-3799
- **Practice address phone:** (313) 824-8224
- **Practice address fax:** (313) 824-8220
- **Mailing address:** 130 E GRAND BLVD, DETROIT, MI 48207-3799
- **Mailing address phone:** (313) 824-8224
- **Mailing address fax:** (313) 824-8220

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 834330 | MI | Yes |

## Other

- **Enumeration date:** 01/03/2006
- **Last updated:** 08/22/2020

## 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 |