Healthcare Provider Details

I. General information

NPI: 1609971662
Provider Name (Legal Business Name): SACRED HEART REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 STODDARD RD
RICHMOND MI
48062-2505
US

IV. Provider business mailing address

400 STODDARD RD
RICHMOND MI
48062-2505
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number101YA0400X
License Number StateMI

VIII. Authorized Official

Name: PAM ARDOIN
Title or Position: CFO
Credential:
Phone: 810-392-2167