Healthcare Provider Details

I. General information

NPI: 1528251071
Provider Name (Legal Business Name): DIVERSIFIED REHAB SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 GREENFIELD RD
ROYAL OAK MI
48073-6528
US

IV. Provider business mailing address

1259 TENNYSON DR
TROY MI
48083-5222
US

V. Phone/Fax

Practice location:
  • Phone: 248-288-6610
  • Fax: 248-288-3910
Mailing address:
  • Phone: 248-703-1157
  • Fax: 248-489-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateMI

VIII. Authorized Official

Name: MS. VAIRA ALJAJAWI
Title or Position: MANAGING MEMBER
Credential: NHA
Phone: 248-703-1157