Provider Demographics
NPI:1336188101
Name:RD SENIOR CARE SERVICES PC
Entity type:Organization
Organization Name:RD SENIOR CARE SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:HEIDENREICH
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:248-363-4143
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:UNION LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48387-0151
Mailing Address - Country:US
Mailing Address - Phone:248-363-4143
Mailing Address - Fax:248-363-2160
Practice Address - Street 1:1157 UNION LAKE RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-4348
Practice Address - Country:US
Practice Address - Phone:248-363-4143
Practice Address - Fax:248-363-2160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Not Answered364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F31774OtherBCBSM
MI4620793Medicaid
MI4525417Medicaid
MI4832042Medicaid
MI4588275Medicaid
MI4832042Medicaid
MI0N66250Medicare ID - Type Unspecified
MI4525417Medicaid
MI4620793Medicaid
MI0N25940Medicare ID - Type Unspecified
MI0N25950Medicare ID - Type Unspecified