# GREENLEY SQUARE MANOR

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

## Provider details

- **NPI number:** 1326299660
- **Authorized official:** MR. TIMOTHY DOUGLAS BERTRAM R.N. (ADMINISTRATOR)
- **Authorized official phone:** (810) 743-5011

## Contact information

- **Practice address:** 1345 CONNELL ST, BURTON, MI 48529-2201
- **Practice address phone:** (810) 743-5011
- **Practice address fax:** (810) 743-7370
- **Mailing address:** 1345 CONNELL ST, BURTON, MI 48529-2201
- **Mailing address phone:** (810) 743-5011
- **Mailing address fax:** (810) 743-7370

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | AL250015221 | MI | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | AM250237981 | MI | Yes |

## Other

- **Enumeration date:** 10/06/2008
- **Last updated:** 10/06/2008