Provider Demographics
NPI:1750961199
Name:POLARIS SPEECH AND NEUROLOGICAL REHABILITATION, LLC
Entity type:Organization
Organization Name:POLARIS SPEECH AND NEUROLOGICAL REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAROCCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-227-4656
Mailing Address - Street 1:PO BOX 834
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-0834
Mailing Address - Country:US
Mailing Address - Phone:330-227-4656
Mailing Address - Fax:
Practice Address - Street 1:2993 ZENAS CT
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-3200
Practice Address - Country:US
Practice Address - Phone:330-227-4656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty