Organization
GENESEE MANOR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY WESLEY RAY I (OWNER)
(313) 449-6895
Entity
Organization
Contact information
Practice address
19415 PURLINGBROOK ST, LIVONIA, MI 48152-1950
(313) 449-6895
(313) 345-6591
Mailing address
19158 SANTA ROSA DR, DETROIT, MI 48221-1732
(313) 449-6895
(313) 945-6591
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
AS820294980
MI
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
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