NPIMap

Organization Active NPI

Sacred Heart Rehabilitation Center, Inc

  • Community/Behavioral Health Agency
  • Flint, MI
National Provider Identifier
1104959493
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
250328 Issued in MI
Legal business name
SACRED HEART REHABILITATION CENTER, INC
Practice address
2091 Professional Dr Ste I-1
Flint, MI 48532-3657
Phone
(810) 732-1652
Fax
(810) 732-1735
NPI assigned
Mar 14, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Grady Wilkinson
Title
President Ceo
Phone
(810) 392-2167

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 250328 MI Primary

Addresses

Primary practice location

2091 Professional Dr Ste I-1
Flint, MI 48532-3657

Mailing address

PO Box 41038
Memphis, MI 48041-1038
Phone (810) 392-2167

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050712000553 MI Part B Supplier - Clinic/Group Practice 5395771240 Receives reassigned benefits from 37 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bay City, MI; Saint Ignace, MI; Saint Clair Shores, MI; Saginaw, MI; Richmond, MI; Port Huron, MI; Madison Heights, MI; Flint, MI…
O20200302001466 MI Part B Supplier - Opioid Treatment Program (Otp) 5395771240 4 other NPIs on this enrollment
Practice locations: Saint Clair Shores, MI; Saint Ignace, MI; Richmond, MI; Madison HTS, MI; Flint, MI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory

Locations

515 Adams St
Bay City, MI 48708
Phone (989) 894-2991

2091 Professional Dr
Ste I
Flint, MI 48532
Phone (810) 732-1652

2091 Professional Dr
Ste I1
Flint, MI 48532
Phone (810) 732-1652

1406 8th St
Port Huron, MI 48060
Phone (810) 531-2704

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104959493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41038",
            "city": "MEMPHIS",
            "state": "MI",
            "postal_code": "480411038",
            "telephone_number": "810-392-2167",
            "fax_number": "810-392-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2091 PROFESSIONAL DR STE I-1",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323657",
            "telephone_number": "810-732-1652",
            "fax_number": "810-732-1735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED HEART REHABILITATION CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "GRADY",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "810-392-2167",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MI",
            "license": "250328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flint, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.