# FAIRLANE SENIOR CARE AND REHAB CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750431276
- **Authorized official:** TODD SANGSTER (CFO)
- **Authorized official phone:** (810) 534-0150

## Contact information

- **Practice address:** 15750 JOY RD, DETROIT, MI 48228-2196
- **Practice address phone:** (313) 273-6850
- **Practice address fax:** (313) 273-5977
- **Mailing address:** 10503 CITATION DR STE 100, BRIGHTON, MI 48116-6551
- **Mailing address phone:** (810) 534-0150
- **Mailing address fax:** (810) 534-0208

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 834360 | MI | Yes |
| 332BN1400X | Nursing Facility Supplies (DME) | 834360 | MI | — |

## Other

- **Enumeration date:** 01/10/2007
- **Last updated:** 05/05/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0H22495 | BCBS DME P&O | MI |
| 05 | — | 4710531 | — | MI |
| 01 | — | S9565 | BCBSM | MI |