1033225842 NPI number — YOUNG REHAB COMPANY PC

Table of content: (NPI 1033225842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033225842 NPI number — YOUNG REHAB COMPANY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUNG REHAB COMPANY PC
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:
1033225842
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3530 E HIAWATHA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKEMOS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48864-4041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-349-4268
Provider Business Mailing Address Fax Number:
517-349-4298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3945 OKEMOS RD STE B2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKEMOS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48864-4210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-349-4268
Provider Business Practice Location Address Fax Number:
517-349-4298
Provider Enumeration Date:
08/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BHARGAVA
Authorized Official First Name:
AJAY
Authorized Official Middle Name:
KUMAR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
517-349-4268

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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