Provider Demographics
NPI:1093021784
Name:MAPLE REHAB LLC
Entity Type:Organization
Organization Name:MAPLE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KANCHARLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-228-4115
Mailing Address - Street 1:100 W KIRBY ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-4044
Mailing Address - Country:US
Mailing Address - Phone:248-228-4115
Mailing Address - Fax:
Practice Address - Street 1:100 W KIRBY ST
Practice Address - Street 2:SUITE 302
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-4044
Practice Address - Country:US
Practice Address - Phone:248-228-4115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)