1437142783 NPI number — COMPLETE REHAB LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437142783 NPI number — COMPLETE REHAB LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE REHAB 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:
1437142783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1380 COOLIDGE HWY STE L50
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48084-7069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-649-3755
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16655 15 MILE RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CLINTON TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-792-0970
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RATHUR
Authorized Official First Name:
ALI
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CCO
Authorized Official Telephone Number:
248-649-3755

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7436128 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 236641 . This is a "HAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30660 . This is a "BCBS MI" identifier . This identifiers is of the category "OTHER".




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