Provider Demographics
NPI:1932106945
Name:PRIME REHAB SERVICES, INC.
Entity Type:Organization
Organization Name:PRIME REHAB SERVICES, INC.
Other - Org Name:PRIME REHAB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:QURATULANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGHUL-PLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-681-0854
Mailing Address - Street 1:33341 DEQUINDRE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4630
Mailing Address - Country:US
Mailing Address - Phone:248-588-1388
Mailing Address - Fax:248-543-5205
Practice Address - Street 1:2590 ELIZABETH LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3314
Practice Address - Country:US
Practice Address - Phone:248-681-0854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30485OtherBCBSM