Healthcare Provider Details

I. General information

NPI: 1174539928
Provider Name (Legal Business Name): SCHARICH I REHAB SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6698 ADARIDGE DR SE
ADA MI
49301-9139
US

IV. Provider business mailing address

6698 ADARIDGE DR SE
ADA MI
49301-9139
US

V. Phone/Fax

Practice location:
  • Phone: 616-682-8339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501005817
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201002994
License Number StateMI

VIII. Authorized Official

Name: MARK SCHARICH
Title or Position: OWNER
Credential:
Phone: 616-682-8339