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General NPI Number Information
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NPI Number | 1710153960
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Entity Type | Organization
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Legal Business Name | SACRED HEART REHABILITATION CENTER, INC
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 17131 GITRE ST
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City | DETROIT
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State | MI
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Zip | 48205-3161
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Country | US
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Telephone | 313-245-4357
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Fax | 313-371-6139
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Provider Business Mailing Address
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Address Line | 400 STODDARD RD
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City | RICHMOND
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State | MI
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Zip | 48062-2505
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Country | US
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Telephone | 810-392-2167
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Fax | 810-392-3530
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | MR. GRADY WILKINSON
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Credential |
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Telephone | 810-392-2167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 823012
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License Number State | MI
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