Provider Demographics
NPI:1780015420
Name:COMMUNITY THERAPEUTIC REHAB LLP
Entity Type:Organization
Organization Name:COMMUNITY THERAPEUTIC REHAB LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-809-9583
Mailing Address - Street 1:28200 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3761
Mailing Address - Country:US
Mailing Address - Phone:248-809-9583
Mailing Address - Fax:
Practice Address - Street 1:28200 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3761
Practice Address - Country:US
Practice Address - Phone:248-809-9583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2488099593305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization