Healthcare Provider Details

I. General information

NPI: 1982980751
Provider Name (Legal Business Name): VIVID IDEA REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 WEST STOKER DR
SAGINAW MI
48604
US

IV. Provider business mailing address

2101 W STOKER DR
SAGINAW MI
48604-2441
US

V. Phone/Fax

Practice location:
  • Phone: 989-239-2376
  • Fax:
Mailing address:
  • Phone: 989-239-2376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DEXTER A MITCHELL SR.
Title or Position: CEO
Credential:
Phone: 989-239-2376