Provider Demographics
NPI:1235883711
Name:CHANNELS REHABILITATION LLC
Entity Type:Organization
Organization Name:CHANNELS REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:IDALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:810-305-0627
Mailing Address - Street 1:109 N 2ND AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-5305
Mailing Address - Country:US
Mailing Address - Phone:989-278-8747
Mailing Address - Fax:989-331-6705
Practice Address - Street 1:109 N 2ND AVE STE 203
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-5305
Practice Address - Country:US
Practice Address - Phone:989-278-8747
Practice Address - Fax:989-331-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation