=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750172979
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REM MICHIGAN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2025
-----------------------------------------------------
Last Update Date | 05/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3595 W WINFIELD DR
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48603-2079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-791-3465
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6600 FRANCE AVE S STE 350
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55435-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-388-5150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP & SR ASST GENERAL COUNSEL
-----------------------------------------------------
Name | MARY PATRICIA RODENBERG-ROBERTS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 952-836-2234
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320700000X
-----------------------------------------------------
Taxonomy Name | Physical Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------