Provider Demographics
NPI:1295016103
Name:SINAI GRACE HOSPITAL
Entity Type:Organization
Organization Name:SINAI GRACE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CARLETA
Authorized Official - Middle Name:
Authorized Official - Last Name:POYDRAS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:313-515-7828
Mailing Address - Street 1:9358 LOUIS
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9358 LOUIS
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1746
Practice Address - Country:US
Practice Address - Phone:313-515-7828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A50400X261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical