Healthcare Provider Details

I. General information

NPI: 1053564252
Provider Name (Legal Business Name): SOUTH LYON SENIOR CARE AND REHAB CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 REYNOLD SWEET PKWY
SOUTH LYON MI
48178-1816
US

IV. Provider business mailing address

10503 CITATION DR STE 100
BRIGHTON MI
48116-6551
US

V. Phone/Fax

Practice location:
  • Phone: 248-437-2048
  • Fax: 248-437-0837
Mailing address:
  • Phone: 810-534-0150
  • Fax: 810-534-0208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number634270
License Number StateMI

VIII. Authorized Official

Name: TODD SANGSTER
Title or Position: CFO
Credential:
Phone: 810-534-0150