Provider Demographics
NPI:1962657742
Name:CORE REHABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:CORE REHABILITATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANEMAECORE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRODITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:313-478-1182
Mailing Address - Street 1:20507 EDMUNTON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3753
Mailing Address - Country:US
Mailing Address - Phone:313-478-1182
Mailing Address - Fax:
Practice Address - Street 1:26000 HOOVER RD STE 100-101
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1167
Practice Address - Country:US
Practice Address - Phone:586-576-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy