Provider Demographics
NPI:1679237010
Name:SGN FUND MANAGEMENT
Entity Type:Organization
Organization Name:SGN FUND MANAGEMENT
Other - Org Name:BALDWIN HOUSE HAZEL PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED PERSONNEL
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-545-0707
Mailing Address - Street 1:777 E WOODWARD HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-2700
Mailing Address - Country:US
Mailing Address - Phone:248-545-0707
Mailing Address - Fax:248-545-0270
Practice Address - Street 1:777 E WOODWARD HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-2700
Practice Address - Country:US
Practice Address - Phone:248-545-0707
Practice Address - Fax:248-545-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332U00000XSuppliersHome Delivered MealsGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty