Provider Demographics
NPI:1346240454
Name:RONALD L. VANCE VANCES REHABILITATION CENTER
Entity Type:Organization
Organization Name:RONALD L. VANCE VANCES REHABILITATION CENTER
Other - Org Name:VANCES REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-732-4753
Mailing Address - Street 1:609 N COURT AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1515
Mailing Address - Country:US
Mailing Address - Phone:989-732-4753
Mailing Address - Fax:989-731-3553
Practice Address - Street 1:609 N COURT AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1515
Practice Address - Country:US
Practice Address - Phone:989-732-4753
Practice Address - Fax:989-731-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501000840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP54878OtherBLUE CARE NETWORK
MI30377OtherBCBS
MI3403920Medicaid
MI3403920Medicaid