Provider Demographics
NPI:1689748972
Name:HARBOR REHABILITATION LLC
Entity Type:Organization
Organization Name:HARBOR REHABILITATION LLC
Other - Org Name:HARBOR REHABILITATION INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:RENKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:616-643-0833
Mailing Address - Street 1:PO BOX 150272
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49515-0272
Mailing Address - Country:US
Mailing Address - Phone:616-643-0833
Mailing Address - Fax:616-643-0844
Practice Address - Street 1:22 JEFFERSON AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4304
Practice Address - Country:US
Practice Address - Phone:616-643-0833
Practice Address - Fax:616-643-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health