# NORTHVILLE MANOR LLC

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

## Provider details

- **NPI number:** 1407516305
- **Authorized official:** FAHIM UDDIN (MEMBER)
- **Authorized official phone:** (248) 593-1990

## Contact information

- **Practice address:** 520 W MAIN ST, NORTHVILLE, MI 48167-1529
- **Practice address phone:** (248) 349-4290
- **Mailing address:** 30700 TELEGRAPH RD STE 2504, BINGHAM FARMS, MI 48025-4571
- **Mailing address phone:** (248) 593-1990

## Taxonomy

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

## Other

- **Enumeration date:** 12/20/2021
- **Last updated:** 12/20/2021