Provider Demographics
NPI:1679571806
Name:WESTLAND CONVALESCENT & REHAB CENTER
Entity type:Organization
Organization Name:WESTLAND CONVALESCENT & REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAROSELLI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:734-728-6100
Mailing Address - Street 1:36137 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2027
Mailing Address - Country:US
Mailing Address - Phone:734-728-6100
Mailing Address - Fax:734-728-9741
Practice Address - Street 1:36137 WARREN RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2027
Practice Address - Country:US
Practice Address - Phone:734-728-6100
Practice Address - Fax:734-728-9741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI824380314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2083147Medicaid
MI09756OtherBCBS OF MICHIGAN
MI235332Medicare ID - Type UnspecifiedMEDICARE
MI2083147Medicaid