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General NPI Number Information
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NPI Number | 1750363305
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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 | 11/18/2005
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Last Update Date | 03/04/2020
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Provider Practice Location 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 | 810-392-3385
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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 | 810-392-3385
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | PAULA NELSON
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 500044
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License Number State | MI
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