Provider Demographics
NPI:1114437159
Name:PREFERRED REHAB CLINIC PC
Entity Type:Organization
Organization Name:PREFERRED REHAB CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HATCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-883-9970
Mailing Address - Street 1:5657 E 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-1511
Mailing Address - Country:US
Mailing Address - Phone:586-883-9970
Mailing Address - Fax:586-883-7550
Practice Address - Street 1:5659 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092
Practice Address - Country:US
Practice Address - Phone:586-883-9970
Practice Address - Fax:586-883-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========Medicaid