Provider Demographics
NPI:1962839860
Name:SANBORN GRATIOT MEMORIAL HOME
Entity Type:Organization
Organization Name:SANBORN GRATIOT MEMORIAL HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANTEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-388-1200
Mailing Address - Street 1:2732 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-2916
Mailing Address - Country:US
Mailing Address - Phone:810-985-5631
Mailing Address - Fax:810-985-5658
Practice Address - Street 1:2732 CHERRY ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-2916
Practice Address - Country:US
Practice Address - Phone:810-985-5631
Practice Address - Fax:810-985-5658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care