Healthcare Provider Details

I. General information

NPI: 1184159030
Provider Name (Legal Business Name): LANDERS REHABILITATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25695 MULBERRY DR
SOUTHFIELD MI
48033-2777
US

IV. Provider business mailing address

25695 MULBERRY DR PO BOX 33202 BLOOMFIELD HILLS
SOUTHFIELD MI
48033-2777
US

V. Phone/Fax

Practice location:
  • Phone: 248-905-3985
  • Fax: 248-281-3476
Mailing address:
  • Phone: 248-905-3985
  • Fax: 248-281-3476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAS630385934
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAS630385934
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberAS630385934
License Number StateMI

VIII. Authorized Official

Name: MRS. NICHOLE A LANDERS
Title or Position: PRESIDENT
Credential:
Phone: 313-213-2916