Provider Demographics
NPI:1073670097
Name:TRI COUNTY REHABILITATION, INC.
Entity Type:Organization
Organization Name:TRI COUNTY REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-427-8210
Mailing Address - Street 1:29217 FORD RD
Mailing Address - Street 2:STE 105
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2889
Mailing Address - Country:US
Mailing Address - Phone:734-427-8210
Mailing Address - Fax:734-427-8209
Practice Address - Street 1:29217 FORD RD
Practice Address - Street 2:STE 105
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2889
Practice Address - Country:US
Practice Address - Phone:734-427-8210
Practice Address - Fax:734-427-8209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30676OtherBCBS
236717Medicare ID - Type Unspecified