Healthcare Provider Details

I. General information

NPI: 1073663498
Provider Name (Legal Business Name): DIAMONDALE NURSING CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 N MICHIGAN RD
DIMONDALE MI
48821-9744
US

IV. Provider business mailing address

10503 CITATION DR SUITE 100
BRIGHTON MI
48116-6549
US

V. Phone/Fax

Practice location:
  • Phone: 517-646-6258
  • Fax: 517-646-0977
Mailing address:
  • Phone: 810-534-0150
  • Fax: 810-534-0208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number234060
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number234060
License Number StateMI

VIII. Authorized Official

Name: TODD SANGSTER
Title or Position: CFO
Credential:
Phone: 810-534-0150