Provider Demographics
NPI:1477530459
Name:NOVACARE REHABILITATION INC
Entity Type:Organization
Organization Name:NOVACARE REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLYN
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:MUETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-450-2001
Mailing Address - Street 1:6515 BARRIE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2305
Mailing Address - Country:US
Mailing Address - Phone:952-922-5019
Mailing Address - Fax:952-922-1384
Practice Address - Street 1:6515 BARRIE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2305
Practice Address - Country:US
Practice Address - Phone:952-922-5019
Practice Address - Fax:952-922-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN24-6551Medicare ID - Type UnspecifiedPT