Provider Demographics
NPI:1447774674
Name:MICHIGAN HOME REHABILITATION L.L.C.
Entity Type:Organization
Organization Name:MICHIGAN HOME REHABILITATION L.L.C.
Other - Org Name:AT HOME REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-827-7715
Mailing Address - Street 1:501 BALDWIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-6904
Mailing Address - Country:US
Mailing Address - Phone:800-880-7715
Mailing Address - Fax:888-830-2614
Practice Address - Street 1:501 BALDWIN ST STE 203
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-6904
Practice Address - Country:US
Practice Address - Phone:800-880-9715
Practice Address - Fax:888-830-2614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1912139288OtherNPI