Provider Demographics
NPI:1013131556
Name:ADVANCED REHABILITATION CLINIC, INC.
Entity Type:Organization
Organization Name:ADVANCED REHABILITATION CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DANESHVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-442-2020
Mailing Address - Street 1:33466 W 8 MILE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-5208
Mailing Address - Country:US
Mailing Address - Phone:248-442-2020
Mailing Address - Fax:248-442-8100
Practice Address - Street 1:33466 W 8 MILE RD STE 111
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-5208
Practice Address - Country:US
Practice Address - Phone:248-442-2020
Practice Address - Fax:248-442-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236597Medicare ID - Type Unspecified