# GENESEE MANOR INC

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

## Provider details

- **NPI number:** 1700165834
- **Authorized official:** GARY WESLEY RAY I (OWNER)
- **Authorized official phone:** (313) 449-6895

## Contact information

- **Practice address:** 19415 PURLINGBROOK ST, LIVONIA, MI 48152-1950
- **Practice address phone:** (313) 449-6895
- **Practice address fax:** (313) 345-6591
- **Mailing address:** 19158 SANTA ROSA DR, DETROIT, MI 48221-1732
- **Mailing address phone:** (313) 449-6895
- **Mailing address fax:** (313) 945-6591

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | AS820294980 | MI | Yes |
| 310400000X | Assisted Living Facility | AS820294980 | MI | — |
| 3104A0625X | Assisted Living Facility (Mental Illness) | AS820294980 | MI | — |
| 3104A0630X | Assisted Living Facility (Behavioral Disturbances) | AS820294980 | MI | — |
| 311ZA0620X | Adult Care Home Facility | AS820294980 | MI | — |

## Other

- **Enumeration date:** 08/07/2011
- **Last updated:** 08/07/2011