Provider Demographics
NPI:1538608096
Name:SAKSHAUG GROUP HOME
Entity type:Organization
Organization Name:SAKSHAUG GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SAKSHAUG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-877-4131
Mailing Address - Street 1:9371 WESTVIEW DR SE
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-9324
Mailing Address - Country:US
Mailing Address - Phone:616-877-4131
Mailing Address - Fax:616-877-4231
Practice Address - Street 1:9371 WESTVIEW DR SE
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9324
Practice Address - Country:US
Practice Address - Phone:616-877-4131
Practice Address - Fax:616-877-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF410290158320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities