1609166511 NPI number — TEAM REHABILITATION WB, LLC

Table of content: (NPI 1609166511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609166511 NPI number — TEAM REHABILITATION WB, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEAM REHABILITATION WB, LLC
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:
1609166511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33900 HARPER AVE
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
CLINTON TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48035-4258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-416-9100
Provider Business Mailing Address Fax Number:
586-416-9103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6405 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
SUITE F1
Provider Business Practice Location Address City Name:
BLOOMFIELD HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48301-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-633-2640
Provider Business Practice Location Address Fax Number:
248-633-2641
Provider Enumeration Date:
04/12/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROONEY
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
586-416-9100

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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