Provider Demographics
NPI:1639157993
Name:EVANGELICAL HOMES OF MICHIGAN
Entity Type:Organization
Organization Name:EVANGELICAL HOMES OF MICHIGAN
Other - Org Name:EVANGELICAL HOME - STERLING HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:PETROSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-836-3499
Mailing Address - Street 1:14900 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2251
Mailing Address - Country:US
Mailing Address - Phone:586-247-4700
Mailing Address - Fax:586-247-1499
Practice Address - Street 1:14900 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-2251
Practice Address - Country:US
Practice Address - Phone:586-247-4700
Practice Address - Fax:586-247-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI504015313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI235473Medicare ID - Type UnspecifiedPROVIDER NUMBER