Organization
BRIGHTON MANOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS EDWARD BOEHM JR. (EXECUTIVE DIRECTOR)
(248) 930-7875
Entity
Organization
Contact information
Practice address
1320 RICKETT RD, BRIGHTON, MI 48116-1833
(248) 930-7875
Mailing address
1320 RICKETT RD, BRIGHTON, MI 48116-1833
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AH470387116
STATE OF MICHIGAN HFA LICENSE
MI
Enumeration date
01/14/2020
Last updated
01/14/2020
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