Provider Demographics
NPI:1245293117
Name:REHABILITATION INSTITUTE INC REHABILITATION INST OF MICHIGAN
Entity type:Organization
Organization Name:REHABILITATION INSTITUTE INC REHABILITATION INST OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PM/PA
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUPPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:313-578-2357
Mailing Address - Street 1:261 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2417
Mailing Address - Country:US
Mailing Address - Phone:313-578-2357
Mailing Address - Fax:313-578-3964
Practice Address - Street 1:261 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2417
Practice Address - Country:US
Practice Address - Phone:313-578-2357
Practice Address - Fax:313-578-3964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI405171735Medicaid
MI301557542Medicaid
MI00258OtherBLUECROSSFACILITYPROVIDER
MI301557542Medicaid