# PINE CREEK MANOR SKILLED NURSING & REHAB CENTER LLC

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

## Provider details

- **NPI number:** 1871088898
- **Authorized official:** FAHIM UDDIN (SOLE MEMBER)
- **Authorized official phone:** (313) 549-7708

## Contact information

- **Practice address:** 34330 VAN BORN RD, WAYNE, MI 48184-2472
- **Practice address phone:** (248) 229-1331
- **Practice address fax:** (248) 593-9120
- **Mailing address:** 30700 TELEGRAPH RD STE 2504, BINGHAM FARMS, MI 48025-4571

## Taxonomy

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

## Other

- **Enumeration date:** 06/22/2018
- **Last updated:** 06/22/2018