Provider Demographics
NPI:1053564252
Name:SOUTH LYON SENIOR CARE AND REHAB CENTER, LLC
Entity type:Organization
Organization Name:SOUTH LYON SENIOR CARE AND REHAB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-534-0150
Mailing Address - Street 1:10503 CITATION DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6551
Mailing Address - Country:US
Mailing Address - Phone:810-534-0150
Mailing Address - Fax:810-534-0208
Practice Address - Street 1:700 REYNOLD SWEET PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1816
Practice Address - Country:US
Practice Address - Phone:248-437-2048
Practice Address - Fax:248-437-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI634270314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5505974Medicaid
MIS9637OtherBCBSM
MI235065Medicare Oscar/Certification