1427226083 NPI number — MICHIGAN REHABILITATION SPECIALISTS, LLC

Table of content: THERESA JILL BURHOE LCSW (NPI 1841984341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427226083 NPI number — MICHIGAN REHABILITATION SPECIALISTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN REHABILITATION SPECIALISTS, 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:
1427226083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMBURG
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48139-0215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-231-6904
Provider Business Mailing Address Fax Number:
810-231-6906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10020 PROFESSIONAL CENTER DRIVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HAMBURG
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-231-6904
Provider Business Practice Location Address Fax Number:
810-231-6906
Provider Enumeration Date:
02/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GOBLE
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
810-231-6904

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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