Redford Geriatric Village, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

834340 Issued in MI

Legal business name

REDFORD GERIATRIC VILLAGE, INC

Practice address

22811 W 7 Mile Rd
Detroit, MI 48219-1739

Phone

(313) 543-1440

Fax

(313) 534-0643

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Donald James Bortz

Title

President

Phone

(586) 759-5966

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303948800000",
    "number": "1104903590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11700 E 10 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480893903",
            "telephone_number": "586-759-5966",
            "fax_number": "586-759-8006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22811 W 7 MILE RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482191739",
            "telephone_number": "313-543-1440",
            "fax_number": "313-534-0643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDFORD GERIATRIC VILLAGE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2011-04-28",
        "status": "A",
        "authorized_official_last_name": "BORTZ",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-759-5966",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "834340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "602084979",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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 28, 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.