Provider Demographics
NPI:1265439483
Name:CENTRAL REHABILITATION, INC.
Entity type:Organization
Organization Name:CENTRAL REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALVEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:248-569-5410
Mailing Address - Street 1:28600 SOUTHFIELD RD
Mailing Address - Street 2:STE 200
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28600 SOUTHFIELD RD
Practice Address - Street 2:STE 200
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2745
Practice Address - Country:US
Practice Address - Phone:248-569-5410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P06280Medicare ID - Type UnspecifiedMAIN GROUP NUMBER
MI0N96710Medicare ID - Type UnspecifiedOT GROUP
MI0N96690Medicare ID - Type UnspecifiedMNT GROUP (DIETICIAN)
MI0N97620Medicare ID - Type UnspecifiedMD GROUP
MI0N96680Medicare ID - Type UnspecifiedMSW GROUP
MI0N96700Medicare ID - Type UnspecifiedPT GROUP