=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962206557
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANDERS ADULT LIVING CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2025
-----------------------------------------------------
Last Update Date | 09/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14848 FENKELL ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48227-2646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-421-8668
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30845 RUNNING STRM APT 22
-----------------------------------------------------
City | FARMINGTON HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48334-1281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-421-8668
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. ALEX CORWIN THOMAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-412-1732
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------