Provider Demographics
NPI:1659480457
Name:STANDISH REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:STANDISH REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALASANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-245-2024
Mailing Address - Street 1:P O BOX 1158
Mailing Address - Street 2:529 S MAIN SUITE G
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658
Mailing Address - Country:US
Mailing Address - Phone:989-846-0937
Mailing Address - Fax:989-846-0936
Practice Address - Street 1:529 S MAIN ST
Practice Address - Street 2:SUITE G
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658
Practice Address - Country:US
Practice Address - Phone:989-846-0937
Practice Address - Fax:989-846-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIH208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0980976OtherHEALTHPLUS
MI1016991OtherMCLARENHP
MI30690OtherBCBS
MI3428910Medicaid
MI3428910Medicaid