Boulevard Manor L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

BOULEVARD MANOR L.L.C.

Practice address

464 E Grand Blvd
Detroit, MI 48207-3637

Phone

(313) 579-2255

Fax

(313) 579-5756

NPI assigned

Nov 1, 2010

Last updated

Apr 20, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fahim Uddin

Title

Authorized Member

Phone

(313) 579-2255

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303257600000",
    "number": "1063712586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 OAKWOOD BLVD",
            "address_2": "SUITE B",
            "city": "MELVINDALE",
            "state": "MI",
            "postal_code": "481221244",
            "telephone_number": "313-579-2255",
            "fax_number": "313-579-5756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "464 E GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482073637",
            "telephone_number": "313-579-2255",
            "fax_number": "313-579-5756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD MANOR L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-01",
        "last_updated": "2011-04-20",
        "status": "A",
        "authorized_official_last_name": "UDDIN",
        "authorized_official_first_name": "FAHIM",
        "authorized_official_title_or_position": "AUTHORIZED MEMBER",
        "authorized_official_telephone_number": "313-579-2255"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jose Antonio Bouffard, M.D.
• Shelly Lauren Bouie, RN
• Spyridon Boukouris, M.D.
• Jamila B Boulaalam, DDS
• Asmaa Boulehia
• Boulevard Temple Care Center, LLC
• Matthew Boulis, DO
• Boundless Eagles Outreach Ministry
• Winston Bourne, LPC
• Latoya Bournes

• Skilled Nursing Facility in Detroit, MI
• Providers in Detroit, MI by specialty
• Skilled Nursing Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.