Provider Demographics
NPI:1114348687
Name:SUPERIOR REHABILITATION & PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:SUPERIOR REHABILITATION & PROFESSIONAL SERVICES, LLC
Other - Org Name:SUPERIOR REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-273-1517
Mailing Address - Street 1:1310 S FRONT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-5185
Mailing Address - Country:US
Mailing Address - Phone:906-273-1517
Mailing Address - Fax:906-273-1519
Practice Address - Street 1:1310 S FRONT ST
Practice Address - Street 2:SUITE C
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-5185
Practice Address - Country:US
Practice Address - Phone:906-273-1517
Practice Address - Fax:906-273-1519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health