1962567438 NPI number — DURAND SENIOR CARE AND REHAB CENTER, LLC

Table of content: (NPI 1962567438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962567438 NPI number — DURAND SENIOR CARE AND REHAB CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DURAND SENIOR CARE AND REHAB CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962567438
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10503 CITATION DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIGHTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48116-6551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-534-0150
Provider Business Mailing Address Fax Number:
810-534-0207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8750 MONROE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48429-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-288-3166
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANGSTER
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
810-534-0150

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  784020 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4984492 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0G81082 . This is a "BCBS DME P&O" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 09609 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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