Provider Demographics
NPI:1326311135
Name:PHASE ONE REHAB, LLC
Entity Type:Organization
Organization Name:PHASE ONE REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARILYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LYTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-733-5022
Mailing Address - Street 1:29155 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 727
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34119 W 12 MILE RD STE 160
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3371
Practice Address - Country:US
Practice Address - Phone:248-733-5022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6833110001Medicare NSC