Provider Demographics
NPI:1780759571
Name:CORE REHAB LLC
Entity type:Organization
Organization Name:CORE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:STALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:989-842-3460
Mailing Address - Street 1:1987 W PINE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48615
Mailing Address - Country:US
Mailing Address - Phone:989-842-3460
Mailing Address - Fax:989-842-5688
Practice Address - Street 1:1987 W PINE RIVER RD
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MI
Practice Address - Zip Code:48615
Practice Address - Country:US
Practice Address - Phone:989-842-3460
Practice Address - Fax:989-842-5688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010668261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy