Provider Demographics
NPI:1710374566
Name:PROSTEP REHABILITATION
Entity Type:Organization
Organization Name:PROSTEP REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:VELTEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-206-7466
Mailing Address - Street 1:16726 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-6043
Mailing Address - Country:US
Mailing Address - Phone:586-206-7466
Mailing Address - Fax:
Practice Address - Street 1:1221 E 16TH ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-9127
Practice Address - Country:US
Practice Address - Phone:616-396-7095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000142314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility