Provider Demographics
NPI:1154685618
Name:PROSTEP REHAB
Entity Type:Organization
Organization Name:PROSTEP REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA/L
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MCNAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-920-7866
Mailing Address - Street 1:7900 W 28TH ST
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3011
Mailing Address - Country:US
Mailing Address - Phone:952-920-7866
Mailing Address - Fax:952-920-8380
Practice Address - Street 1:7900 W 28TH ST
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3011
Practice Address - Country:US
Practice Address - Phone:952-920-7866
Practice Address - Fax:952-920-8380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXTENDICARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility