Healthcare Provider Details

I. General information

NPI: 1326094855
Provider Name (Legal Business Name): AMBROSE REHABILITATION CONSULTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 HAMILTON RD
OKEMOS MI
48864-1700
US

IV. Provider business mailing address

2109 HAMILTON RD
OKEMOS MI
48864-1700
US

V. Phone/Fax

Practice location:
  • Phone: 517-648-2939
  • Fax: 517-575-0253
Mailing address:
  • Phone: 517-648-2939
  • Fax: 517-575-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number6801067102
License Number StateMI

VIII. Authorized Official

Name: MRS. ELIZABETH JANE PINER
Title or Position: DIRECTOR
Credential: LMSW
Phone: 517-648-2939