Provider Demographics
NPI:1669615993
Name:ACTIVE REHAB GROUP LLC
Entity type:Organization
Organization Name:ACTIVE REHAB GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:KABBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-269-2700
Mailing Address - Street 1:110 E HURON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-1313
Mailing Address - Country:US
Mailing Address - Phone:989-550-4035
Mailing Address - Fax:
Practice Address - Street 1:110 E HURON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1313
Practice Address - Country:US
Practice Address - Phone:989-550-4035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID27150273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit