Organization Name: | SANBORN GRATIOT MEMORIAL HOME |
NPI Number: | 1962839860 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KATHLEEN SWANTEK (EXECUTIVE DIRECTOR) |
Mailing Address: | 2732 Cherry St Port Huron |
State: | MI US |
Postal Code: | 480602916 |
Phone Number: | 8109855631 |
Fax Number: | 8109855658 |
NPI Enumeration Date: | 10/09/2013 |
NPI Last Update Date: | 10/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 385H00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Respite Care Facility |
Taxonomy Classification: | Respite Care |
Taxonomy Specialization: | |
Taxonomy Definition: |