Provider Demographics
NPI:1568411023
Name:YPSILANTI REHABILITATION SERVICES, INC.
Entity Type:Organization
Organization Name:YPSILANTI REHABILITATION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDOULAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:NDAW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:734-485-4544
Mailing Address - Street 1:6055 RAWSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2546
Mailing Address - Country:US
Mailing Address - Phone:734-485-4544
Mailing Address - Fax:734-485-8125
Practice Address - Street 1:6055 RAWSONVILLE RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-2546
Practice Address - Country:US
Practice Address - Phone:734-485-4544
Practice Address - Fax:734-485-8125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004671225100000X
MI5501011753225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICV0029050Medicaid