Healthcare Provider Details

I. General information

NPI: 1629002829
Provider Name (Legal Business Name): CORA HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S ORTONVILLE ROAD
ORTONVILLE MI
48462
US

IV. Provider business mailing address

1110 SHAWNEE ROAD
LIMA OH
45805
US

V. Phone/Fax

Practice location:
  • Phone: 348-627-4084
  • Fax: 248-627-4998
Mailing address:
  • Phone: 419-221-6712
  • Fax: 419-222-0507

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. BRAD C ROUSH
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 419-221-6712