Provider Demographics
NPI:1659368546
Name:SAGINAW GERIATRICS HOME LLC
Entity Type:Organization
Organization Name:SAGINAW GERIATRICS HOME LLC
Other - Org Name:SAGINAW GERIATRICS HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HAMZA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-355-6050
Mailing Address - Street 1:1413 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-2628
Mailing Address - Country:US
Mailing Address - Phone:989-793-3671
Mailing Address - Fax:989-793-2428
Practice Address - Street 1:1413 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-2628
Practice Address - Country:US
Practice Address - Phone:989-793-3671
Practice Address - Fax:989-793-2428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAGINAW VALLEY REAL ESTATE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-05
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI734150314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2153564Medicaid
MI235442Medicare PIN