Healthcare Provider Details

I. General information

NPI: 1487106944
Provider Name (Legal Business Name): SAMARITAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4354 MOUNT HOPE RD
WILLIAMSBURG MI
49690-9210
US

IV. Provider business mailing address

8131 E JEFFERSON AVE
DETROIT MI
48214-2610
US

V. Phone/Fax

Practice location:
  • Phone: 231-938-4673
  • Fax:
Mailing address:
  • Phone: 313-823-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JENNY CEDERSTROM
Title or Position: CFO
Credential:
Phone: 313-308-2764