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Organization
SHANTA CORPORATION
Active
Organization
SHANTA CORPORATION
Active
Other names
ST ANNES CONVALESCENT CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS BEAUVAIS (ADMINISTRATOR)
(313) 886-2500
Entity
Organization
Contact information
Practice address
6232 CADIEUX RD, DETROIT, MI 48224-3812
(313) 886-2500
Mailing address
6232 CADIEUX RD, DETROIT, MI 48224-3812
(313) 886-2500
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
MI834710
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548356
—
MI
01
—
235415
MEDICARE
MI
01
—
MI834710
STATE LICENSE NUMBER
MI
Enumeration date
10/06/2005
Last updated
12/28/2011
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