GREENLEY SQUARE MANOR (NPI# 1326299660) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326299660 |
| Entity Type | Organization |
| Organization Name | GREENLEY SQUARE MANOR |
| Practice Address |
1345 Connell St Burton MI 48529-2201 |
| Practice Telephone | 8107435011 |
| Practice Fax Number | 8107437370 |
| Mailing Telephone | 8107435011 |
| Mailing Fax Number | 8107437370 |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2008-10-06 |
| Authorized Official Name | MR. TIMOTHY DOUGLAS BERTRAM (ADMINISTRATOR) |
| Authorized Official Telephone | 8107435011 |
| Authorized Official Credential | R.N. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | AL250015221 | MI | Residential Treatment Facilities |
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | AM250237981 | MI | Residential Treatment Facilities |
| Street Address |
1345 CONNELL ST |
| City | BURTON |
| State | MI |
| Zip Code | 48529-2201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336690866 | Flatrock Manor of Burton Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1345 Connell St, Burton, MI 48529-2201 | 2016-10-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245874551 | Tonya Mary Lott | Nurse Practitioner | 3375 S. Saginaw St, Burton, MI 48529 | 2019-10-30 |
| 1093241028 | Christie Bigelow | Behavior Technician | 4476 South Dort Hwy, Burton, MI 48529 | 2017-05-11 |
| 1164961033 | Strive Center for Autism LLC | Behavioral Analyst | 4476 S Dort Hwy, Burton, MI 48529 | 2017-02-13 |
| 1013382357 | Joy Sandy | Nurse Practitioner | 3525 Saginaw Road, Burton, MI 48529 | 2015-12-12 |
| 1407253206 | Caring Hands Home Health Services | Home Health | G-3163 Flushing Road, 208, Flint, MI 48529 | 2014-11-24 |
| 1427489293 | Shauna Renee Miller | Physician Assistant | G-3375 S Saginaw St, Burton, MI 48529 | 2013-12-04 |
| 1801234521 | Amy Lyn Gomez | Registered Nurse | 1336 Allen St, Burton, MI 48529 | 2013-06-05 |
| 1285962720 | Burton Pharmacy Inc | Pharmacy | 3375 S Saginaw St, Burton, MI 48529 | 2009-11-20 |
| 1912128919 | Juliette Marie Perzhinsky | Internal Medicine | 3525 Saginaw Rd., Burton, MI 48529 | 2007-05-01 |
| 1639153075 | Loretta Catherine Nimmo | Nurse Practitioner | 3373 S. Saginaw St, Burton, MI 48529 | 2005-11-30 |
| Find all providers in zip 48529 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336690866 | Flatrock Manor of Burton Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1345 Connell St, Burton, MI 48529-2201 | 2016-10-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770199507 | Laura Lisa Gonzalez | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 7134 Blankenship Cir, Davison, MI 48423-2317 | 2020-09-17 |
| 1558984377 | Angel Patient Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 12601 E Outer Dr, Detroit, MI 48224-4204 | 2020-05-27 |
| 1659990208 | Lydias House | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 11667 152nd Ave, West Olive, MI 49460-9232 | 2020-04-14 |
| 1124667118 | Alternative Community Living, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2678 S Waverly Hwy, Lansing, MI 48911-6303 | 2019-12-23 |
| 1215579537 | Eden Prairie Residential Care Services, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 302 Welch Blvd, Flint, MI 48503-1105 | 2019-10-09 |
| 1518428333 | Alternative Adult Residence LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 19163 Woodingham Dr, Detroit, MI 48221-1650 | 2019-03-26 |
| 1245701960 | Teresa Elaine Guzman | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 130 Marvin St, Battle Creek, MI 49017-8040 | 2018-12-06 |
| 1508334764 | Marquette Staffing Agency, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 592 Blemhuber Ave, Marquette, MI 49855-4818 | 2018-11-06 |
| 1912481235 | Adrienne Flowers | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 18403 Kentucky St, Detroit, MI 48221-2029 | 2018-09-21 |
| 1417431487 | Helping Hands Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5116 18th Rd, Escanaba, MI 49829-9525 | 2018-09-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.