Provider Demographics
NPI:1629393566
Name:ADVANCED REHAB SERVICES
Entity Type:Organization
Organization Name:ADVANCED REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KURTIS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MANGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-948-1107
Mailing Address - Street 1:645 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2341
Mailing Address - Country:US
Mailing Address - Phone:330-952-1031
Mailing Address - Fax:
Practice Address - Street 1:645 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2341
Practice Address - Country:US
Practice Address - Phone:330-952-1031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-04
Last Update Date:2011-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care