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NPI Code Detail

MEDICARE: SACRED HEART REHABILITATION CENTER, INC.

MEDICARE: SACRED HEART REHABILITATION CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency
2324500000XSubstance Abuse Rehabilitation Facility500044MI

General Provider Information

NPI Number : 1750363305
Entity Type Code : Organization
Provider Name (Legal Business Name) : SACRED HEART REHABILITATION CENTER, INC.
Provider Business Mailing Address
First Line : 400 STODDARD RD
Second Line :
City : RICHMOND
State : MI
Zip : 48062-2505
Country : US
Telephone Number : 810-392-2167
Fax Number : 810-392-3385
Provider Business Practice Location Address
First Line : 400 STODDARD RD
Second Line :
City : RICHMOND
State : MI
Zip : 48062-2505
Country : US
Telephone Number : 810-392-2167
Fax Number : 810-392-3385
Authorized Official
Title or Position : PRESIDENT/CEO
Name : PAULA NELSON
Credential :
Telephone Number : 810-392-2167
Provider Enumeration Date : 11/18/2005
Last Update Date : 03/04/2020

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