Provider Demographics
NPI:1184159030
Name:LANDERS REHABILITATION SERVICES LLC
Entity type:Organization
Organization Name:LANDERS REHABILITATION SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-213-2916
Mailing Address - Street 1:25695 MULBERRY DR
Mailing Address - Street 2:PO BOX 33202 BLOOMFIELD HILLS
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2777
Mailing Address - Country:US
Mailing Address - Phone:248-905-3985
Mailing Address - Fax:248-281-3476
Practice Address - Street 1:25695 MULBERRY DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-2777
Practice Address - Country:US
Practice Address - Phone:248-905-3985
Practice Address - Fax:248-281-3476
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANDERS & LANDERS HOME FOR THE AGED INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS630385934310400000X, 311ZA0620X, 320700000X
261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities