Healthcare Provider Details

I. General information

NPI: 1386062586
Provider Name (Legal Business Name): KINGDOM REHABILATATION GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 TOWN CTR 1900
SOUTHFIELD MI
48075-1135
US

IV. Provider business mailing address

2000 TOWN CTR 1900
SOUTHFIELD MI
48075-1135
US

V. Phone/Fax

Practice location:
  • Phone: 248-633-8511
  • Fax: 313-864-7701
Mailing address:
  • Phone: 248-633-8511
  • Fax: 313-864-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DORENEA BYRD
Title or Position: CHEIF EXECUTIVE OFFICER
Credential:
Phone: 248-633-8511