1811015548 NPI number — IN HOME REHAB OF DICKINSON COUNTY

Table of content: (NPI 1811015548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811015548 NPI number — IN HOME REHAB OF DICKINSON COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IN HOME REHAB OF DICKINSON COUNTY
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:
1811015548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
W3101 RIDGECREST RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VULCAN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-563-8920
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N19748 TIMM'S LAKE ROAD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
NIAGARA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-563-8920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARLSON
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
906-563-8920

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5501003532 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: 5201002404 , 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)





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