Provider Demographics
NPI:1629495239
Name:MINERVA REHABILITATION SERVICES
Entity Type:Organization
Organization Name:MINERVA REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AD
Authorized Official - Prefix:MR
Authorized Official - First Name:BUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-560-5080
Mailing Address - Street 1:2301 DORSEY RD STE 111C
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3299
Mailing Address - Country:US
Mailing Address - Phone:240-560-5080
Mailing Address - Fax:855-639-0043
Practice Address - Street 1:2301 DORSEY RD STE 111C
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3299
Practice Address - Country:US
Practice Address - Phone:240-560-5080
Practice Address - Fax:855-639-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3587251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health