Bolton Brook Manor

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

BOLTON BROOK MANOR

Practice address

4554 Thomas Rd
Metamora, MI 48455-9220

Phone

(810) 678-2087

Fax

(810) 678-2766

NPI assigned

Jul 27, 2020

Organization subpart

No

Name

Mr. Sunil R Bhattad

Title

Administrator

Phone

(248) 797-8519

Locations

• Caremore of Metamora Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 27, 2020.

{
    "created_epoch": "1595808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595808000000",
    "number": "1497364442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4554 THOMAS RD",
            "city": "METAMORA",
            "state": "MI",
            "postal_code": "484559220",
            "telephone_number": "810-678-2087",
            "fax_number": "810-678-2766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4554 THOMAS RD",
            "city": "METAMORA",
            "state": "MI",
            "postal_code": "484559220",
            "telephone_number": "810-678-2087",
            "fax_number": "810-678-2766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLTON BROOK MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-27",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A",
        "authorized_official_last_name": "BHATTAD",
        "authorized_official_first_name": "SUNIL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "248-797-8519",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Caremore of Metamora",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Roy Mumin Alisoglu, CRNA
• Paige Elizabeth Bailey
• Ashley Baker
• Michael John Boyd
• Jordan V Buscemi, PHARMACY STUDENT
• Andria Leigh Connor, COTA/L
• Eric E Craig, LLP
• Jeannie Craig, TLLP, LLPC

• All providers in Metamora, MI
• Assisted Living Facility (Mental Illness) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2020; 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.