Healthcare Provider Details

I. General information

NPI: 1083607238
Provider Name (Legal Business Name): SAMARITAS LUTHERAN SOCIAL SERVICES OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3161 DAVENPORT
SAGINAW MI
48602
US

IV. Provider business mailing address

8131 E. JEFFERSON
DETROIT MI
48214
US

V. Phone/Fax

Practice location:
  • Phone: 989-799-1902
  • Fax: 989-799-0805
Mailing address:
  • Phone: 313-823-7700
  • Fax: 313-823-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number734110
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10700000219
License Number StateMI

VIII. Authorized Official

Name: MRS. JENNY CEDERSTROM
Title or Position: CHIEF FINANCE OFFICER
Credential:
Phone: 586-506-0325