1427056696 NPI number — TRI-REHAB, INC.

Table of content: (NPI 1427056696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427056696 NPI number — TRI-REHAB, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI-REHAB, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427056696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45610 CHERRY HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48187-5072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-981-1500
Provider Business Mailing Address Fax Number:
734-981-1515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2421 MONROE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124-3043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-593-1703
Provider Business Practice Location Address Fax Number:
313-593-1939
Provider Enumeration Date:
07/12/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BERRY
Authorized Official First Name:
ANN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
734-981-1500

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30412 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 64126565 . This is a "BC COMPLETE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 30412 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".