Provider Demographics
NPI:1477581486
Name:MARINA REHABILITATION AND HEALTH SERVICES
Entity Type:Organization
Organization Name:MARINA REHABILITATION AND HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-650-1984
Mailing Address - Street 1:1050 W UNIVERSITY DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1877
Mailing Address - Country:US
Mailing Address - Phone:248-650-1984
Mailing Address - Fax:248-650-1994
Practice Address - Street 1:1050 W UNIVERSITY DR
Practice Address - Street 2:SUITE 3
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1877
Practice Address - Country:US
Practice Address - Phone:248-650-1984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005736332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI460114387Medicaid
MI540F322220OtherBCBS DME
MI5032140001Medicare NSC