Healthcare Provider Details

I. General information

NPI: 1750374914
Provider Name (Legal Business Name): SAMARITAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 32ND ST SE
GRAND RAPIDS MI
49508-7909
US

IV. Provider business mailing address

8131 E JEFFERSON AVE
DETROIT MI
48214-2610
US

V. Phone/Fax

Practice location:
  • Phone: 616-452-5900
  • Fax: 616-452-4271
Mailing address:
  • Phone: 313-823-7700
  • Fax: 313-823-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number414021
License Number StateMI

VIII. Authorized Official

Name: JENNY CEDERSTROM
Title or Position: CFO
Credential:
Phone: 313-823-7700