Provider Demographics
NPI:1942392782
Name:DEARBORN MEDICAL & REHABILITATION CENTER
Entity Type:Organization
Organization Name:DEARBORN MEDICAL & REHABILITATION CENTER
Other - Org Name:DEARBORN MEDICAL & REHABILITATION CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARIDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILARTE
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:313-724-0224
Mailing Address - Street 1:23917 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1207
Mailing Address - Country:US
Mailing Address - Phone:313-724-0224
Mailing Address - Fax:313-724-0232
Practice Address - Street 1:23917 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1207
Practice Address - Country:US
Practice Address - Phone:313-724-0224
Practice Address - Fax:313-724-0232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P21500Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER