Provider Demographics
NPI:1518914142
Name:GENERAL REHAB MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:GENERAL REHAB MANAGEMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:F
Authorized Official - Last Name:MOORES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:734-459-1800
Mailing Address - Street 1:PO BOX 702880
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-0988
Mailing Address - Country:US
Mailing Address - Phone:734-459-1800
Mailing Address - Fax:734-459-3831
Practice Address - Street 1:38253 ANN ARBOR RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3432
Practice Address - Country:US
Practice Address - Phone:734-632-0330
Practice Address - Fax:734-632-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30389OtherBLUE CROSS BLUE SHIELD
MI30389OtherBLUE CROSS BLUE SHIELD