Organization
GREENLEY SQUARE MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY DOUGLAS BERTRAM R.N. (ADMINISTRATOR)
(810) 743-5011
Entity
Organization
Contact information
Practice address
1345 CONNELL ST, BURTON, MI 48529-2201
(810) 743-5011
(810) 743-7370
Mailing address
1345 CONNELL ST, BURTON, MI 48529-2201
(810) 743-5011
(810) 743-7370
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
AL250015221
MI
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
AM250237981
MI
Other
Enumeration date
10/06/2008
Last updated
10/06/2008
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