Provider Demographics
NPI:1073663498
Name:DIAMONDALE NURSING CARE CENTER, LLC
Entity Type:Organization
Organization Name:DIAMONDALE NURSING CARE CENTER, LLC
Other - Org Name:DIMONDALE NURSING CARE CENTER
Other - Org Type:Doing Business As
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
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6549
Mailing Address - Country:US
Mailing Address - Phone:810-534-0150
Mailing Address - Fax:810-534-0208
Practice Address - Street 1:4000 N MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:DIMONDALE
Practice Address - State:MI
Practice Address - Zip Code:48821-9744
Practice Address - Country:US
Practice Address - Phone:517-646-6258
Practice Address - Fax:517-646-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI234060314000000X, 332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B31063OtherBCBS DME P&O
MI4624237Medicaid
MI09572OtherBCBSM
MI0B31063OtherBCBS DME P&O
MI235256Medicare Oscar/Certification