Healthcare Provider Details

I. General information

NPI: 1316993835
Provider Name (Legal Business Name): GOLDEN TRIANGLE REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28051 DEQUINDRE RD STE D
MADISON HEIGHTS MI
48071-3016
US

IV. Provider business mailing address

28051 DEQUINDRE RD STE D
MADISON HEIGHTS MI
48071-3016
US

V. Phone/Fax

Practice location:
  • Phone: 248-733-5442
  • Fax: 248-963-6214
Mailing address:
  • Phone: 248-733-5442
  • Fax: 248-963-6214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: DINA KAMAL ASMAR
Title or Position: ADMINISTRATOR OWNER
Credential:
Phone: 619-402-7927