Provider Demographics
NPI:1730466103
Name:ACHEIVE INDEPENDANCE WITH REHABILITATION, LLC
Entity Type:Organization
Organization Name:ACHEIVE INDEPENDANCE WITH REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUKUS
Authorized Official - Suffix:
Authorized Official - Credentials:OCCUPATIONAL THERAPI
Authorized Official - Phone:301-461-4497
Mailing Address - Street 1:7510 CONTEE RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-9244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7510 CONTEE RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-9244
Practice Address - Country:US
Practice Address - Phone:301-461-4497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-13
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05219225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty