Healthcare Provider Details

I. General information

NPI: 1679237010
Provider Name (Legal Business Name): SGN FUND MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E WOODWARD HEIGHTS BLVD
HAZEL PARK MI
48030-2700
US

IV. Provider business mailing address

777 E WOODWARD HEIGHTS BLVD
HAZEL PARK MI
48030-2700
US

V. Phone/Fax

Practice location:
  • Phone: 248-545-0707
  • Fax: 248-545-0270
Mailing address:
  • Phone: 248-545-0707
  • Fax: 248-545-0270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: JILLIAN TISCH
Title or Position: AUTHORIZED PERSONNEL
Credential:
Phone: 248-545-0707