Provider Demographics
NPI:1699878728
Name:SACRED HEART
Entity type:Organization
Organization Name:SACRED HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:EIFERT
Authorized Official - Suffix:
Authorized Official - Credentials:CACII
Authorized Official - Phone:810-392-2167
Mailing Address - Street 1:7094 BRYCE RD
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:MI
Mailing Address - Zip Code:48049-3400
Mailing Address - Country:US
Mailing Address - Phone:810-324-6077
Mailing Address - Fax:
Practice Address - Street 1:400 STODDARD RD.
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:MI
Practice Address - Zip Code:48041
Practice Address - Country:US
Practice Address - Phone:810-392-2167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI#500044322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children