Provider Demographics
NPI:1164443420
Name:ADVANCED NEURO REHAB SERVICES INC.
Entity Type:Organization
Organization Name:ADVANCED NEURO REHAB SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARANATH
Authorized Official - Middle Name:
Authorized Official - Last Name:POLICHERLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-548-6400
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:ATTN: LYNDA THOMPSON
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-1108
Mailing Address - Country:US
Mailing Address - Phone:734-677-7400
Mailing Address - Fax:734-677-7407
Practice Address - Street 1:26635 WOODWARD AVE
Practice Address - Street 2:STE. 101
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1372
Practice Address - Country:US
Practice Address - Phone:248-548-6400
Practice Address - Fax:248-548-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M89910Medicare ID - Type Unspecified