Basic Information
| Provider Information | |||||||||
| NPI: | 1942510516 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SACRED HEART REHABILITATION CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 E 12 MILE RD | ||||||||
| Address2: | |||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480712651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103922167 | ||||||||
| FaxNumber: | 8103923530 | ||||||||
| Practice Location | |||||||||
| Address1: | 28303 DEQUINDRE RD | ||||||||
| Address2: | |||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480713040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486581116 | ||||||||
| FaxNumber: | 2486581120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2010 | ||||||||
| LastUpdateDate: | 10/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8103922167 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 631337 | MI | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | SA631337 | 01 | MI | LICENSE | OTHER |