Provider Demographics
NPI:1508848318
Name:MARY FREE BED REHABILITATION, L.L.C
Entity Type:Organization
Organization Name:MARY FREE BED REHABILITATION, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:DENEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-840-8317
Mailing Address - Street 1:1845 LIVERNOIS RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1731
Mailing Address - Country:US
Mailing Address - Phone:248-362-2150
Mailing Address - Fax:248-362-1702
Practice Address - Street 1:1845 LIVERNOIS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1731
Practice Address - Country:US
Practice Address - Phone:248-362-2150
Practice Address - Fax:248-362-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI01686225100000X, 2251G0304X, 2251H1200X, 2251N0400X, 2251P0200X, 2251S0007X, 2251X0800X
MI5201002959225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Single Specialty
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4669868OtherAETNA
MI89046AOtherHAP
MI30688OtherBCBSM
MI16854OtherMCARE
MI134812400OtherUS DEPT OF LABOR
MI382473857OtherPPOM
MIP459578OtherBLUE CHOICE