Provider Demographics
NPI:1295808087
Name:FOX RUN VILLAGE, INC.
Entity type:Organization
Organization Name:FOX RUN VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RG ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:LANDREVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:248-668-8655
Mailing Address - Street 1:41000 THIRTEEN MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:248-926-5200
Mailing Address - Fax:248-668-8687
Practice Address - Street 1:41000 THIRTEEN MILE RD.
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:248-926-5200
Practice Address - Fax:248-668-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility