Provider Demographics
NPI:1710508569
Name:SANTIAS PLACE LLC
Entity Type:Organization
Organization Name:SANTIAS PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-425-1942
Mailing Address - Street 1:7370 CORNWALL CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4069
Mailing Address - Country:US
Mailing Address - Phone:248-421-5194
Mailing Address - Fax:
Practice Address - Street 1:7370 CORNWALL CT
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4069
Practice Address - Country:US
Practice Address - Phone:248-425-1942
Practice Address - Fax:248-719-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty