Provider Demographics
NPI:1649972126
Name:RANDALL RESIDENCE OF STERLING HEIGHTS
Entity type:Organization
Organization Name:RANDALL RESIDENCE OF STERLING HEIGHTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SUFNAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-254-5719
Mailing Address - Street 1:13400 19 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1950
Mailing Address - Country:US
Mailing Address - Phone:586-254-5719
Mailing Address - Fax:
Practice Address - Street 1:13400 19 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1950
Practice Address - Country:US
Practice Address - Phone:586-254-5719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency