Healthcare Provider Details

I. General information

NPI: 1003653130
Provider Name (Legal Business Name): CASCADE SENIOR CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 ROBINSON RD
JACKSON MI
49203-3658
US

IV. Provider business mailing address

10503 CITATION DR STE 100
BRIGHTON MI
48116-6551
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-4150
  • Fax:
Mailing address:
  • Phone: 810-534-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

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