Healthcare Provider Details

I. General information

NPI: 1336336817
Provider Name (Legal Business Name): SAMARITAN HOMES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22610 ROSEWOOD ST
OAK PARK MI
48237-2904
US

IV. Provider business mailing address

22610 ROSEWOOD ST
OAK PARK MI
48237-2904
US

V. Phone/Fax

Practice location:
  • Phone: 248-399-8115
  • Fax:
Mailing address:
  • Phone: 248-399-8115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH JORDAN
Title or Position: EXECTUIVE DIRECTOR
Credential:
Phone: 248-399-8115