Healthcare Provider Details

I. General information

NPI: 1477680965
Provider Name (Legal Business Name): HEARTLAND REHABILITATION SERVICES OF MICHIGAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 S OLD WOODWARD AVE
BIRMINGHAM MI
48009-6705
US

IV. Provider business mailing address

3425 EXECUTIVE PKWY SUITE 128
TOLEDO OH
43606-1326
US

V. Phone/Fax

Practice location:
  • Phone: 248-594-4269
  • Fax: 248-594-7381
Mailing address:
  • Phone: 419-537-0764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BARRY A LAZARUS
Title or Position: VICE PRESIDENT - REIMBURSEMENTS
Credential:
Phone: 419-252-5541