Provider Demographics
NPI:1538798731
Name:WINDEMERE PARK OF TROY OPERATIONS LLC
Entity type:Organization
Organization Name:WINDEMERE PARK OF TROY OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-981-0813
Mailing Address - Street 1:30078 SCHOENHERR RD STE 300
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-3178
Mailing Address - Country:US
Mailing Address - Phone:586-563-1500
Mailing Address - Fax:586-541-8540
Practice Address - Street 1:5990 N ADAMS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-2377
Practice Address - Country:US
Practice Address - Phone:248-602-2400
Practice Address - Fax:248-602-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility