Healthcare Provider Details

I. General information

NPI: 1083937080
Provider Name (Legal Business Name): SACRED HEART ADULT CARE HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19251 DOYLE RD
GREGORY MI
48137-9405
US

IV. Provider business mailing address

19251 DOYLE RD
GREGORY MI
48137-9405
US

V. Phone/Fax

Practice location:
  • Phone: 734-498-2277
  • Fax: 734-498-2277
Mailing address:
  • Phone: 734-498-2277
  • Fax: 734-498-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAM470015102
License Number StateMI

VIII. Authorized Official

Name: ANNETTE M PRINGLE
Title or Position: DIRECTOR
Credential:
Phone: 734-498-2277