Provider Demographics
NPI:1578767612
Name:MARIS GROVE, INC
Entity Type:Organization
Organization Name:MARIS GROVE, INC
Other - Org Name:MARIS GROVE OUTPATIENT REHABILITATION AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:RATHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-402-2390
Mailing Address - Street 1:100 MARIS GROVE WAY
Mailing Address - Street 2:ATTN: EXECUTIVE DIRECTOR
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1282
Mailing Address - Country:US
Mailing Address - Phone:610-387-4470
Mailing Address - Fax:410-204-7237
Practice Address - Street 1:100 MARIS GROVE WAY
Practice Address - Street 2:ATTN: REHABILITATION MANAGER
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1282
Practice Address - Country:US
Practice Address - Phone:610-387-4470
Practice Address - Fax:410-204-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396840Medicare Oscar/Certification