Provider Demographics
NPI:1346294287
Name:MONROEREHABCONNECTION LLC
Entity Type:Organization
Organization Name:MONROEREHABCONNECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBEROWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAROSLAW
Authorized Official - Middle Name:ANDRZEJ
Authorized Official - Last Name:LATALA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:734-242-0101
Mailing Address - Street 1:1038 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3113
Mailing Address - Country:US
Mailing Address - Phone:734-242-0101
Mailing Address - Fax:
Practice Address - Street 1:1038 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3113
Practice Address - Country:US
Practice Address - Phone:734-242-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004877261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P32770Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MIP32770001Medicare ID - Type UnspecifiedPROVIDER NUMBER