Provider Demographics
NPI:1417727165
Name:PASADENA VILLA MICHIGAN, LLC
Entity Type:Organization
Organization Name:PASADENA VILLA MICHIGAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SARNACKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-442-7689
Mailing Address - Street 1:5440 CORPORATE DR STE 125
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5440 CORPORATE DR STE 125
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-2619
Practice Address - Country:US
Practice Address - Phone:615-864-8145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health