NPIMap

Organization Active NPI

Presbyterian Village East

  • Physical Therapy Clinic/Center
  • Chesterfield, MI
National Provider Identifier
1710539606
Registry record updated Jul 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PRESBYTERIAN VILLAGE EAST
Doing business as
The Village of East Harbor
Practice address
33875 Kiely Dr
Chesterfield, MI 48047-3604
Phone
(586) 716-7410
Fax
(586) 716-7404
NPI assigned
Jul 11, 2019
Organization subpart
Yes
Parent organization
PRESBYTERIAN VILLAGE EASTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 11, 2019

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

Authorized official

Name
Mr. David M. Miller
Title
Vice President
Phone
(586) 716-7410

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

33875 Kiely Dr
Chesterfield, MI 48047-3604

Mailing address

33875 Kiely Dr
Chesterfield, MI 48047-3604
Phone (586) 716-7410

Other names 1

  • The Village of East Harbor Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200224001198 MI Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 2567451487 Practice locations: Chesterfield, MI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Presbyterian Village Ea2 organizations share this tax ID, including this one
Part of
Presbyterian Village Ea

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Presbyterian Villiage of MichiganChesterfield, MI, CCN 235528 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 8, 1993

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1562803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562803200000",
    "number": "1710539606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33875 KIELY DR",
            "city": "CHESTERFIELD",
            "state": "MI",
            "postal_code": "480473604",
            "telephone_number": "586-716-7410",
            "fax_number": "586-716-7404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33875 KIELY DR",
            "city": "CHESTERFIELD",
            "state": "MI",
            "postal_code": "480473604",
            "telephone_number": "586-716-7410",
            "fax_number": "586-716-7404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN VILLAGE EAST",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRESBYTERIAN VILLAGE EAST",
        "enumeration_date": "2019-07-11",
        "last_updated": "2019-07-11",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "586-716-7410",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Village of East Harbor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chesterfield, MI

Sources for this page

Verify at the official NPI Registry.