COURTYARD MANOR OF WIXOM (NPI# 1134348311) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134348311 |
| Entity Type | Organization |
| Organization Name | COURTYARD MANOR OF WIXOM |
| Practice Address |
48578 Pontiac Trl Wixom MI 48393-2554 |
| Mailing Address |
3275 Martin Rd Suite 127 Commerce Township MI 48390-1642 |
| Practice Telephone | 2486695263 |
| Practice Fax Number | 2486695035 |
| Mailing Telephone | 2489262920 |
| Mailing Fax Number | 2489262933 |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. RONALD M. PARADOWICZ (VICE PRESIDENT) |
| Authorized Official Telephone | 2489262920 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
MI | Nursing & Custodial Care Facilities | |
| N | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
MI | Nursing & Custodial Care Facilities | |
| N | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
MI | Nursing & Custodial Care Facilities | |
| Y | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
MI | Nursing & Custodial Care Facilities |
| Street Address |
48578 PONTIAC TRL |
| City | WIXOM |
| State | MI |
| Zip Code | 48393-2554 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871020883 | Caitlyn Finzel | Social Worker | 48578 Pontiac Trl, Wixom, MI 48393-2554 | 2017-05-22 |
| 1932651015 | Michael Mogan | Social Worker | 48578 Pontiac Trl, Wixom, MI 48393-2554 | 2016-10-25 |
| 1205387685 | Tracy Jones Duvall | Social Worker | 48578 Pontiac Trl, Wixom, MI 48393-2554 | 2016-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669907507 | Nikita Waller | Specialist/Technologist, Other | 28345 Beck Road, Ste. 103, Wixom, MI 48393 | 2017-04-28 |
| 1356897086 | Amber Kay Smith | Technician, Other | 403 Meadows Circle South, Wixom, MI 48393 | 2016-09-01 |
| 1306259718 | Omaka Mokambe | Licensed Practical Nurse | 47915 Thornwood St Apt 11103, Wixom, MI 48393 | 2014-06-04 |
| 1932491487 | Carla's Comp-anionship & Care LLC | Point of Service | 30739 Tamarack St. #40101, Wixom, MI 48393 | 2011-05-03 |
| 1790981900 | Positive Reflections Empowerment Center | Community/Behavioral Health | 47922 Fernwood 12107, Wixom, MI 48393 | 2007-06-25 |
| 1871635409 | Lawrence Robert Weiss | Chiropractor | 49295 West Rd, Wixom, MI 48393 | 2007-02-12 |
| 1295803096 | William Jason Finn | Chiropractor | 3255 W Maple, Suite B, Wixom, MI 48393 | 2006-12-01 |
| 1629148853 | J & B Medical Supply Co Inc | Durable Medical Equipment & Medical Supplies | 50496 W Pontiac Trail, Wixom, MI 48393 | 2006-11-08 |
| 1487613899 | Shawn William Grant | Physical Therapist | 29822 Wixom Rd., Wixom, MI 48393 | 2006-03-23 |
| 1346732401 | Dana Chirico | Specialist/Technologist, Other | 28345 Beck Road, Ste. 103, Wixom, MI 48393 | 2018-06-05 |
| Find all providers in zip 48393 | ||||
| Taxonomy Code | 3104A0625X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Mental Illness |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154947703 | Bay City Comfort Care | Assisted Living Facility | 4130 Shrestha Dr, Bay City, MI 48706-2184 | 2020-06-19 |
| 1548807142 | Mother of Grace LLC | Assisted Living Facility | 7947 Tulane St, Taylor, MI 48180-2321 | 2019-12-03 |
| 1881231629 | Better Life Residential Care Inc | Assisted Living Facility | 4444 Lincoln Blvd, Dearborn Hts, MI 48125-2568 | 2019-11-27 |
| 1700433042 | Golden Life Afc LLC | Assisted Living Facility | 10710 Roy Dr, Greenville, MI 48838-9105 | 2019-08-21 |
| 1225513468 | Harmony Hearts Village LLC | Assisted Living Facility | 7773 Sherwood St, Detroit, MI 48211-1785 | 2018-10-03 |
| 1699277004 | Leann Renee Gastelum | Assisted Living Facility | 19301 Winthrop St, Detroit, MI 48235 | 2018-03-01 |
| 1245769991 | Mecca House Corporation | Assisted Living Facility | 53 West Huron, Pontiac, MI 48342 | 2017-06-07 |
| 1225564768 | Country Haven | Assisted Living Facility | 413 E Muskegon St, Cedar Springs, MI 49319-9596 | 2017-05-03 |
| 1205382389 | B&r Holistic Care Housing, LLC | Assisted Living Facility | 19303 Mark Twain St, Detroit, MI 48235-1914 | 2016-08-29 |
| 1841683158 | Hill's Support Services Inc. | Assisted Living Facility | 6430 Washington St, Romulus, MI 48174-1742 | 2015-03-11 |
| Find all providers with the same taxonomy | ||||
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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.