PARK GERIATRIC VILLAGE, INC (NPI# 1528145901) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528145901 |
| Entity Type | Organization |
| Organization Name | PARK GERIATRIC VILLAGE, INC |
| Practice Address |
111 Ford St Highland Park MI 48203-3622 |
| Mailing Address |
11700 E 10 Mile Rd Warren MI 48089-3903 |
| Practice Telephone | 3138833858 |
| Practice Fax Number | 3138839142 |
| Mailing Telephone | 5867595966 |
| Mailing Fax Number | 5867598006 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. DONALD JAMES BORTZ (PRESIDENT) |
| Authorized Official Telephone | 5867595966 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 824130 | MI | Nursing & Custodial Care Facilities |
| Street Address |
111 FORD ST |
| City | HIGHLAND PARK |
| State | MI |
| Zip Code | 48203-3622 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780140236 | Darryl Seldon | Speech-Language Pathologist | 111 Ford St, Highland Park, MI 48203-3622 | 2019-02-20 |
| 1104325240 | Sharice Bausley | Occupational Therapy Assistant | 111 Ford St, Highland Park, MI 48203-3622 | 2018-02-05 |
| 1346749488 | Monil I Patel | Physical Therapist | 111 Ford St, Highland Park, MI 48203-3622 | 2018-02-05 |
| 1225418304 | Highland Park Opco, LLC | Skilled Nursing Facility | 111 Ford St, Highland Park, MI 48203-3622 | 2015-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992355135 | James Calloway | Peer Specialist | 1211 E Mcnichols, Detroit, MI 48203 | 2019-09-19 |
| 1851868582 | Community Veterans Services Inc | Counselor | 163 Tennyson, Highland Park, MI 48203 | 2018-10-31 |
| 1346601838 | Rainbow Center of Michigan | Health Maintenance Organization | 12501 Hamilton Ave., Highland Park, MI 48203 | 2016-03-11 |
| 1134502354 | Minds Moving In New Directions Inc | Community/Behavioral Health | 62 Massachusetts St, Highland Park, MI 48203 | 2015-07-07 |
| 1811312937 | Brea Holloway | Home Health | 20249 Yacama Rd, Detroit, MI 48203 | 2014-02-26 |
| 1770821795 | St John Providence Health Systems | Community/Behavioral Health | 1150 Lantz St, Detroit, MI 48203 | 2013-01-25 |
| 1871845412 | Waneta Darcell Dickerson | Social Worker | 169 W. Buena Vista, Highlandpark, MI 48203 | 2012-10-05 |
| 1629331939 | Maureen Connolly | Pediatrics | 77 Victor St, Highland Park, MI 48203 | 2012-06-21 |
| 1578850251 | Detroit Recovery Project | Community/Behavioral Health | 1121 East Mc Nichols, Detroit, MI 48203 | 2011-07-01 |
| 1265728414 | Barbara Suzanne Tyson | Home Health | 301 Glendale St, Apt B8, Highland Park, MI 48203 | 2011-06-27 |
| Find all providers in zip 48203 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477807881 | Susan Iverson | Skilled Nursing Facility | 1582 Arbor Ave, Highland Park, IL 60035 | 2012-11-07 |
| 1124027677 | Amberwood Convalescent Hospital Inc | Skilled Nursing Facility | 6071 York Blvd, Highland Park, CA 90042-3503 | 2005-07-18 |
| 1225418304 | Highland Park Opco, LLC | Skilled Nursing Facility | 111 Ford St, Highland Park, MI 48203-3622 | 2015-06-04 |
| 1194714618 | Evanston Northwestern Healthcare | Skilled Nursing Facility | 718 Glenview Ave, Highland Park, IL 60035-2432 | 2005-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538798731 | Windemere Park of Troy Operations LLC | Skilled Nursing Facility | 5990 N Adams Rd, Troy, MI 48098-2377 | 2020-04-08 |
| 1982235396 | Berg-lahser Snf, LLC | Skilled Nursing Facility | 21630 Hessel Ave # 1230, Detroit, MI 48219-1230 | 2020-02-04 |
| 1508497918 | Harmony Village Snf, LLC | Skilled Nursing Facility | 16588 Schaefer Hwy # 4249, Detroit, MI 48235-4249 | 2020-02-04 |
| 1336795244 | Ishpeming Nursing & Rehab Center, LLC | Skilled Nursing Facility | 435 Rd Pl, Ishpeming, MI 49849 | 2019-08-15 |
| 1669965299 | Wellbridge of Clarkston, LLC | Skilled Nursing Facility | 5655 Clarkston Road, Independence Township, MI 48348 | 2018-06-08 |
| 1104318112 | Wellbridge At Genesys Health Park, LLC | Skilled Nursing Facility | 3139 East Baldwin Road, Grand Blanc, MI 48439 | 2018-06-05 |
| 1427549955 | Mission Point of Detroit, LLC | Skilled Nursing Facility | 2102 Orleans, Detroit, MI 48207 | 2018-05-21 |
| 1912496324 | Regency At Independence Township, LLC | Skilled Nursing Facility | 6211 Stonewood Drive, Clarkston, MI 48346 | 2018-05-02 |
| 1972092344 | Regency At Grand Haven, LLC | Skilled Nursing Facility | 17049 Comstock St, Grand Haven, MI 49417-7903 | 2018-05-01 |
| 1093214173 | Sana Nasir Inc. | Skilled Nursing Facility | 13840 King Rd, Riverview, MI 48193 | 2018-02-05 |
| Find all providers with the same taxonomy | ||||
| City | HIGHLAND PARK |
| Zip Code | 48203 |
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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.