Provider Demographics
NPI:1174845465
Name:SARAS HEART
Entity type:Organization
Organization Name:SARAS HEART
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INDEPEDENT CONTRACTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANEQUA
Authorized Official - Middle Name:YENAE
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:313-808-3314
Mailing Address - Street 1:2320 STONEPATH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-1189
Mailing Address - Country:US
Mailing Address - Phone:313-808-3314
Mailing Address - Fax:
Practice Address - Street 1:2320 STONEPATH ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-1189
Practice Address - Country:US
Practice Address - Phone:313-808-3314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI47031011853104A0630X
OHPN 115400313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances