Provider Demographics
NPI:1790974988
Name:NOUR REHABILITATION CENTER ,INC
Entity Type:Organization
Organization Name:NOUR REHABILITATION CENTER ,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSTAFA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOUR
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:219-663-7081
Mailing Address - Street 1:503 E SUMMIT ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3377
Mailing Address - Country:US
Mailing Address - Phone:219-663-7081
Mailing Address - Fax:219-663-7091
Practice Address - Street 1:503 E SUMMIT ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3377
Practice Address - Country:US
Practice Address - Phone:219-663-7081
Practice Address - Fax:219-663-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004040A261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy