Provider Demographics
NPI:1780266718
Name:SACRED HEART REHABILITATION CENTER, INC
Entity type:Organization
Organization Name:SACRED HEART REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ARDOIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-392-2167
Mailing Address - Street 1:400 STODDARD RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-2505
Mailing Address - Country:US
Mailing Address - Phone:810-392-2167
Mailing Address - Fax:
Practice Address - Street 1:248 FERRY LN
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-1828
Practice Address - Country:US
Practice Address - Phone:810-392-2167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0490025Medicaid