Provider Demographics
NPI:1881685204
Name:RJR SARMIENTO COMPANY, LLC
Entity type:Organization
Organization Name:RJR SARMIENTO COMPANY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLDAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SARMIENTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-978-2359
Mailing Address - Street 1:2107 E 14 MILE RD
Mailing Address - Street 2:110
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5970
Mailing Address - Country:US
Mailing Address - Phone:586-978-2359
Mailing Address - Fax:586-978-2372
Practice Address - Street 1:2107 E 14 MILE RD
Practice Address - Street 2:110
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5970
Practice Address - Country:US
Practice Address - Phone:586-978-2359
Practice Address - Fax:586-978-2372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI508011251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237480Medicare ID - Type UnspecifiedPROVIDER NUMBER