Provider Demographics
NPI:1295155448
Name:SAVANNAH SPECIALIZED ROOM & BOARD
Entity type:Organization
Organization Name:SAVANNAH SPECIALIZED ROOM & BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:313-731-7166
Mailing Address - Street 1:169 CORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3510
Mailing Address - Country:US
Mailing Address - Phone:313-731-7166
Mailing Address - Fax:
Practice Address - Street 1:169 CORTLAND ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3510
Practice Address - Country:US
Practice Address - Phone:313-731-7166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service