Healthcare Provider Details

I. General information

NPI: 1972701670
Provider Name (Legal Business Name): SACRED HEART REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58144 GRATIOT AVE
NEW HAVEN MI
48048
US

IV. Provider business mailing address

400 STODDARD RD
MEMPHIS MI
48041
US

V. Phone/Fax

Practice location:
  • Phone: 586-749-5173
  • Fax:
Mailing address:
  • Phone: 810-392-2167
  • Fax: 810-392-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number500441
License Number StateMI

VIII. Authorized Official

Name: MR. GRADY WILKINSON
Title or Position: PRESIDENT, CEO
Credential:
Phone: 810-392-2167