Organization
FAIRLANE SENIOR CARE AND REHAB CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD SANGSTER (CFO)
(810) 534-0150
Entity
Organization
Contact information
Practice address
15750 JOY RD, DETROIT, MI 48228-2196
(313) 273-6850
(313) 273-5977
Mailing address
10503 CITATION DR STE 100, BRIGHTON, MI 48116-6551
(810) 534-0150
(810) 534-0208
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
834360
MI
332BN1400X
Nursing Facility Supplies (DME)
834360
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H22495
BCBS DME P&O
MI
05
—
4710531
—
MI
01
—
S9565
BCBSM
MI
Enumeration date
01/10/2007
Last updated
05/05/2022
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