Healthcare Provider Details

I. General information

NPI: 1699324731
Provider Name (Legal Business Name): SACRED HEART REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 E GREIG AVE
MADISON HEIGHTS MI
48071-3826
US

IV. Provider business mailing address

400 STODDARD RD
RICHMOND MI
48062-2505
US

V. Phone/Fax

Practice location:
  • Phone: 248-658-1116
  • Fax:
Mailing address:
  • Phone: 810-392-2167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMMY MURRAY
Title or Position: ADMIN ASST
Credential:
Phone: 810-392-2167