Provider Demographics
NPI:1356406979
Name:HART REHAB SPECIALISTS LLC
Entity type:Organization
Organization Name:HART REHAB SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-953-0760
Mailing Address - Street 1:PO BOX 831
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48480-0831
Mailing Address - Country:US
Mailing Address - Phone:810-953-0760
Mailing Address - Fax:810-953-0833
Practice Address - Street 1:3033 GRAND BLANC RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439
Practice Address - Country:US
Practice Address - Phone:810-953-0760
Practice Address - Fax:810-953-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540B515220OtherBLUE CROSS BLUE SHIELD
MI4979429Medicaid
MI4979429Medicaid