Provider Demographics
NPI:1801844220
Name:COMPLETE CARE REHAB LLC
Entity Type:Organization
Organization Name:COMPLETE CARE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:PADMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:586-285-0545
Mailing Address - Street 1:31370 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-2450
Mailing Address - Country:US
Mailing Address - Phone:586-285-0545
Mailing Address - Fax:586-439-2902
Practice Address - Street 1:31370 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-2450
Practice Address - Country:US
Practice Address - Phone:586-285-0545
Practice Address - Fax:586-279-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007610273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N94050Medicare ID - Type UnspecifiedGROUP