Healthcare Provider Details

I. General information

NPI: 1205372240
Provider Name (Legal Business Name): AZUL REHAB SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2017
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5078 FAIRVIEW ST
DETROIT MI
48213-3447
US

IV. Provider business mailing address

20935 ANITA ST
HARPER WOODS MI
48225-1126
US

V. Phone/Fax

Practice location:
  • Phone: 313-770-5510
  • Fax: 313-469-9509
Mailing address:
  • Phone: 313-770-5510
  • Fax: 313-469-9509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number5201002626
License Number StateMI

VIII. Authorized Official

Name: TEAL JANINE WILKERSON
Title or Position: OWNER
Credential: OTR/L
Phone: 313-770-5510