Provider Demographics
NPI:1326079120
Name:ST MARK REHABILITATION AND HEALTH SERVICES
Entity Type:Organization
Organization Name:ST MARK REHABILITATION AND HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-650-1984
Mailing Address - Street 1:134 W UNIVERSITY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1951
Mailing Address - Country:US
Mailing Address - Phone:248-650-1984
Mailing Address - Fax:248-650-1994
Practice Address - Street 1:5601 ASTER DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-3871
Practice Address - Country:US
Practice Address - Phone:248-650-1984
Practice Address - Fax:248-650-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005736332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5153970001Medicare ID - Type Unspecified