Provider Demographics
NPI:1134222318
Name:FAIR ACRES NURSING HOME, INC.
Entity type:Organization
Organization Name:FAIR ACRES NURSING HOME, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-784-5322
Mailing Address - Street 1:22600 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARMADA
Mailing Address - State:MI
Mailing Address - Zip Code:48005-3237
Mailing Address - Country:US
Mailing Address - Phone:586-784-5322
Mailing Address - Fax:586-784-8779
Practice Address - Street 1:22600 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ARMADA
Practice Address - State:MI
Practice Address - Zip Code:48005-3237
Practice Address - Country:US
Practice Address - Phone:586-784-5322
Practice Address - Fax:586-784-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI50-4060314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1584263Medicaid
MIS9558OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI23-5609Medicare Oscar/Certification